Clyde Dee's Blog, page 2

What to do if you think you might be experiencing psychosis

Did you know that mental health challenges affect millions of people each year? In 2021, a staggering 57.8 million people in the United States experienced a mental health challenge. 

These numbers highlight the important impact that mental health has on our society and the urgent need for understanding, support, and practical resources to address this growing concern. 

It touches the lives of people from all walks of life. Mental health challenges know no boundaries and can affect anyone, regardless of age, gender, race, or social status. It’s complex and takes on various forms.

One such mental health challenge, which comes a great deal of stigma, discrimination, and stereotypes, is psychosis. Experiencing symptoms of psychosis can be distressing and confusing because the sufferer doesn’t know what to expect and doesn’t want to be confined to a mental institution for the rest of their life. 

It’s important to understand that psychosis is a condition that leads to a great deal of misunderstanding and mistreatment. Many people who have endured psychosis talk about having a bad time not only with the experiences but also with the way they were treated.

Remember, one in ten people worldwide experience hearing voices, and many do not find the experiences distressing or related to their mental health. Below, we’ll review psychosis symptoms, causes, prevention, related conditions, schizophrenia, and treatments. Remember, you’re not alone, and help and hope are available.

What Are the Symptoms of Psychosis?

Psychosis is a psychological condition in which a person is accused of having lost touch with reality. It is a set of experiences that shape how people think, feel, and act. These are some of the most common warning signs that a person may be experiencing psychosis.

Hallucinations and Delusions

Hallucinations are when you see, hear, smell, taste, or feel things that other people don’t. Some people believe they are having sensations that come from their mind rather than from something happening around you. People who experience hallucinations come up with a lot of interesting explanations for what is happening to them. For example, some believe they can see or hear other dimensions of reality. Some people believe there have been technological advances that enable governments or powerful people to impose these experiences. And, in fact, some of these technologies do exist. These experiences are real, even though there’s no clearly identifiable external stimulus causing them.

Delusions are when someone strongly believes in things that go against what is thought to be reality by most people. These beliefs can seem irrational or impossible, but for those who are experiencing the experiences associated with psychosis, it makes no sense to see the world in any other way. For example, a person starts to collect experiences that indicate they are being followed. As coincidences and serendipities increase and as evidence comes at them from a variety of different sources, they may become convinced they are being watched by hidden cameras; they may conclude this is happening because they have superpowers; they may feel extremely important in a way that doesn’t match how others see them.

Again, these delusions are “real” to a person with psychosis. They can significantly impact how a person thinks, acts, and interacts with others.

Disorganized Thinking and Speech

Psychosis makes the brain work very hard and leads to preoccupation with thoughts about the stimuli (hallucinations or other experiences) that so distresses the person. Then, the person is asked to carry out regular activities in life and it appears like their thoughts and speech are disorganized. This can lead to:

Conversations that don’t make senseSpeech that jumps aroundTrouble focusing on a topic

Thoughts may suddenly appear to be fragmented as the sufferer can’t possibly articulate all that is in their head. In this manner, it becomes challenging to articulate coherent ideas or communicate effectively. 

Lack of Motivation and Social Withdrawal

Psychosis is characterized by a noticeable loss of motivation and interest in everyday tasks. Instead, the person becomes focused more on what is immediately necessary for their survival. The following types of observed behavior may start to apply:

Loss of interest in things they used to enjoyLow motivation in getting tasks startedTrouble staying focused and concentrating

Social withdrawal is also common. This is because the person may feel alone or afraid of being judged or labeled because of their condition. This can continue even when a person has recovered from other parts of psychosis.

Causes of Psychosis

Each person who experiences psychosis is on a journey. The potential causes of this journey are different and might vary widely from person to person. Industries are built around the concept that psychosis is caused by:  

GeneticsChemical imbalancesAnatomical abnormalities in the brain

Indeed, if you look at a college textbook, you will see a lot of evidence in support of these claims like twin studies and pictures of severe brain damage. This causes many of us to forget that there are “life” factors that can either start or intensify symptoms. For example, the following:

Substance abuseSuffering a traumatic experienceChronic stress Life transitions

It is important to work with mental health professionals who are curious and open-minded about the causes of psychosis. Too many have read textbooks and see statistics instead of a person. It is important to craft different treatments for different individuals that are based on the idea that the person can recover and adapt to the challenges they are facing. 

Psychosis Prevention Strategy

Even though it may not always be possible to stop experiences that lead to psychosis from happening, there is a great deal of learning that can help a person manage. Still there may be times of overwhelm and a person needs to work hard to remain healthy and functioning. Keeping your mental state of mind in good shape is essential by using a psychosis prevention strategy.

You can do this by making healthy living choices. For example, the following can all help with overall mental health:

Regular exerciseHaving a healthy, well-balanced dietGetting enough sleepLearning how to deal with stress

Building a solid support network and getting professional help at the first sign of trouble are important ways to prevent symptoms from worsening.

Other Conditions Linked to Psychosis

Psychosis can be a symptom of various other underlying conditions. For instance, other conditions linked to psychosis could be the following:

Bipolar disorderSchizoaffective disorderMajor depressive disorder with psychotic features

Still many other “disorders” coincide with psychosis and are similar. Sometimes a mix of neurodevelopmental disorders underlie experiences with psychosis, disorders such as:

AutismDyslexiaADHDOCD

Also, many disorders associated with trauma may likewise underlie and mix to cause experiences of psychosis, disorders such as:

PTSDPersonality DisordersDissociative Disorders

Substance-induced psychosis may occur due to drug use, particularly stimulants or hallucinogens. Certain medical conditions, such as brain tumors or infections or dementia, can also lead to psychosis. Recognizing and diagnosing the underlying conditions is essential for effective treatment and management of psychosis.

Psychosis vs. Schizophrenia

It’s important to note the distinction between psychosis vs. schizophrenia. While psychosis refers to symptoms, schizophrenia is a specific mental disorder.

It has several signs and symptoms, one of which is psychosis. Schizophrenia often causes long-term problems with how a person thinks, feels, and sees the world. On the other hand, psychosis can happen as a short-term event.

A mental health worker must make a correct diagnosis to develop the right treatment plan and give the right kind of help.

Treatments for Psychosis

Treatments for psychosis are usually treated with varied methods tailored to each person’s needs. Antipsychotics and other medicines can help control symptoms and make them less severe.

There are other treatments, such as behavioral interventions. For example, the following:

Cognitive-behavioral therapyFamily therapy

These can help people learn how to deal with problems and feel better generally. Peer support groups and community tools can also help give understanding, compassion, and direction.

Psychosis Unveiled!

Experiencing symptoms of psychosis can be overwhelming, but remember that help is available. Understanding the encompassing signs, help, and support is essential to treating psychosis.

People can obtain help and resources for their recovery. Remember, you are not alone; with proper care, it is possible to regain control and lead a fulfilling life.

Taking that first step towards seeking help is an empowering act that can lead to a brighter future. Reach out, speak up, and embrace the journey of healing. You deserve support, understanding, and the opportunity to live a fulfilling life.

If you are seeking valuable resources and support for navigating psychosis, look no further than Tim Dreby’s website. Visit the website to access a wealth of information and tools tailored to individuals experiencing psychosis.

The post What to do if you think you might be experiencing psychosis appeared first on Redefining "Psychosis".

How to Deal with Psychosis, Help Loved Ones Deal With It

In the United States, there are some estimates that suggest that approximately 50 in 10,000 people may experience psychosis or a psychotic episode at some point in their lifetime. At the same time there are estimates that 1 in every 100 people in the U.S. alone carry a diagnosis of schizophrenia, which is suggestive of a much larger presence of psychosis. Then again, there is the estimate put out by the hearing voices network, an international movement, that 1 in 10 people hear voices worldwide. The differences in these different statistics are shocking. Why do estimates vary so widely?

It is arguable that there are political reasons for suggesting that “psychosis” is so infrequent. When psychosis is depicted as rare, it helps justify that subjecting people to long term incarceration or warehousing is appropriate treatment. It suggests that nothing else can be done for this small percentage of ill individuals. In fact, I believe that having bouts of psychosis is much more frequent and tends to be underreported because people are afraid they will be called crazy and subjugate to demeaning treatment.

I have often heard that psychosis exists on more of a continuum and that it affects people to varying degrees. Some people are influenced to a lesser degree and can sustain important roles in society, while others become totally overwhelmed and lose the ability to function due to associated distress. I think if we understand psychosis as a wide array of experiences that many more people can relate to having these experiences. Many people have these experiences and develop thoughts that aren’t so realistic. When understood in this manner there are more therapeutic strategies that start to make sense and a lot more help to be made available.

Witnessing a psychotic episode can be terrifying. It can be nerve-wracking when you don’t know what to do when a loved one needs help. Indeed, it is common for many family members to start out being overly protective and scared about the safety of their loved one. Often this period of overprotection can be followed by a sense of hopelessness, a worsening relationship, and eventually referring the family member to a system that promotes warehousing. Read on to learn more about what you can do to get your loved one the support they need to heal and sustain a full recovery.

Psychosis: What Is It?

Often people think of psychosis as a diagnosed mental disorder, but this isn’t true. In the DSM (the diagnostic statistic manual of mental disorders,) psychosis is a cluster of behavioral observations regularly seen in several mental health disorders.

I have learned to treat psychosis across diagnostic divides and tend not to believe that disorders exist as they are described in the DSM. I propose that a better definition is to identify a long list of experiences that many people may be able to relate to that so preoccupy the mind that it can seem to an outsider that the person has trouble telling the difference between what is real and what isn’t.

According to the DSM, a person dealing with psychosis may experience hallucinations and delusions. When experiencing hallucinations, a person’s brain will pick up on sensory inputs that others do not experience. These hallucinations can affect all five senses, leading the person suffering from psychosis to hear, see, smell, taste, or even feel things that no one else can observe.

Again, according to the DSM, delusions are when someone believes in something that most people would suggest is untrue. I believe they continue to experience the world in ways that cause them to think in different kinds of manners. For example, some people with delusions believe they are being followed.  For another example, a person suffering from delusions may firmly believe that someone or something outside of themselves has control over their thoughts and actions. This can lead to behaviors that can be observed and labeled psychotic because of the associated conflict and distress.

In fact, when a person experiences trauma-related dissociation a different alter or part of a person can take over the body and control their thoughts and actions. Many times, when people have their views invalidated repeatedly as they do when they are told they have a delusion, they may develop this same phenomenon of dissociation in concert with their delusions. In fact, as I have worked with people who carry psychotic labels over the years, I have found that ultimately this overlap is extremely common. Understanding this can help us understand behavior that is thought to be psychotic.

What Are the Common Causes of Psychosis?

Certain mental health disorders include episodes of psychosis as a symptom. According to the DSM-5, Schizophrenia Spectrum and Other Psychotic Disorders fit this category. Common mental disorders that can cause psychosis include:

Brief psychotic disorderDelusional disorderPsychotic disorder due to medicationSchizophreniaSchizoaffective disorderSchizophreniform disorderSchizotypal (personality) disorderSubstance-induced psychotic disorder

Still many other disorders that are in the DSM V also can result in psychosis. For example, those with bipolar disorder and major depression can develop psychosis symptoms. Medical conditions such as Alzheimer’s can cause a person to experience psychosis. Research shows that 1 in 500 women experience postpartum psychosis after giving birth. Additionally, those who have severe head injuries and traumatic experiences can develop psychosis symptoms. Often extreme experiences with developmental disorders such as ADHD, Dyslexia, Autism and OCD can result in a person developing psychosis. Also, substance abuse can result in psychosis.

I have calculated that there are a total of thirty disorders in the DSM 5 that involve psychosis and so I have trained myself to listen to peoples’ experiences across diagnostic divides. Additionally, there are often other mental health struggles that are going on beneath a person’s psychosis that can be harshly exacerbated by receiving “treatment” associated with psychosis. Things like trauma, anxiety, depression, and substance abuse can become much worse because of experiencing what is thought to be a “psychotic” break.

People with lived experience develop very interesting thoughts about the cause of psychosis, as do professionals. Often, getting better involves diversifying one’s causation ideas. It is very positive when people with different perspectives work together to understand new facets. I believe that there are styles of causation theory. I teach that there are: political, spiritual, traumatic psychological, scientific, and artistic explanations for a person’s journey through madness. Understanding all perspectives is an important part of getting better.

Psychosis Risk Factors

Some individuals are thought to have a higher risk of developing psychosis than others. I tend to want to dispel these risk factors as I think they reflect a lot of stigma. Psychosis risk factors are thought to include:

Family history of certain mental disordersDrug or alcohol abuseSevere mental, emotional, or physical traumaBrain cysts, tumors, or damageGenetic mutationsCertain medical conditions, including dementia, HIV, and other infections

There is a widely publicized link between genetics and the risk of developing psychosis. While there is a large amount of funding that has been put to proving the genetic link, little definitive evidence has been produced. What we hear from experts is that so much more research is needed to possibly prove a link. When something is suggestive of a genetic link, it is amplified in the literature because so many people want to hear that psychosis is caused by genetics.

Many people with lived experience are open to the idea that they are spiritually gifted. I believe that many individuals in a psychosis crisis do have psychic abilities that complicate matters and confuse people. Perhaps it is arguable that there is a spiritual gene that might be isolated and proven to exist. I believe that many people who presume a genetic link, presume there are inferior or problematic genes and tend to have eugenic misconceptions. Unfortunately, this can result in a lot of stigma and mistreatment of people who have experienced psychosis. This is often seen on psychiatric wards when staff people think they are above the patients, and it is unfortunate.

I am partial towards understanding the role that abuse and social exclusion plays in developing psychosis. Consider the famous psychologist, Carl Jung, who fell into madness when Sigmund Freud betrayed him or the famous sociologist Emile Durkheim who fell into madness during his massive suicide study under the social pressure of people who did not think that he would not be able to complete the project. Such examples suggest that under the right conditions any body could fall into madness regardless of their role in life.

Early Psychosis Warning Signs

Early warning signs of psychosis can be challenging to detect since it is usually a gradual process that starts with seemingly small changes in behavior. To make it even more difficult to identify, early warning signs can affect nearly any area of a person’s behavior, from thought processes and speech patterns to emotional and social changes.

While there are a huge number of early warning signs of psychosis, some of the most common may include:

Belief that their environment has changedChange in language structure or speech patternsDifficulty focusing or thinking clearlyWithdrawing or isolating from social situationsExtreme, unwarranted aggressionDecline in self-care and personal hygieneNew or worsening sleep disturbancesShowing a decrease in emotionsActing suspicious or paranoid

I have heard of many stories of people who heard voices as kids at certain points and how they never had problems until they told others about their experience. Often speaking about voice experiences cause voices to become critical and threatening causing them to get referred to treatment. Unfortunately, what many people with lived experience report is that many forms of “treatment” cause things to get worse. Treatments like psychiatric incarceration, involuntary medication, seclusion, and restraints often take intolerable situations and make them worse. This is why I advocate for the public to get a better understanding about what psychosis is and learn basic interventions so that the more traumatic treatments become less necessary.

How Can You Help a Loved One With Psychosis?

It can be difficult to know and understand what you can do to provide psychosis help to a loved one, especially if they are in a psychotic episode. If you’re trying to offer good support and care to a loved one dealing with psychosis, here are some suggestions:

Don’t fight with them: People struggling to grasp reality will see or hear things others are not experiencing. Your first reaction may be to get angry and argue with them about what’s real. Instead, stay calm and discuss with them what they’re experiencing.

Ask them how you can help them: If your loved one seems to be in distress during a psychotic episode, consider gently asking them what you can do to help. While this may not always work, in some cases they may be able to direct you in a way that is specific to their needs.

Discuss the importance of seeking help: Your loved one may hesitate to seek treatment for their psychosis. As I stated before, a great deal of mental health treatment can be perceived as negative and indeed have negative outcomes. Thus, it is important that you don’t advocate for those measures.  Learn about recovery-oriented help that does not involve a future of being warehoused. Ask yourself if the suggested course of action is likely to lead your loved one down a path of recovery and healing or trauma and abuse.  Then it makes sense to advocate for them to trust the help that is available to them. Additionally, it can really be helpful if you are willing to work with them to find the right treatment.

What if They Become a Danger to Themselves?

Many people benefit from medication and other treatments that help them stay in touch with reality. After receiving proper medical and mental health attention, it’s not uncommon to see improvement in psychosis-related symptoms. Of course, it helps when you can help to assemble a team of trusted professionals that respect the self-determination of your loved one and believe in their recovery. However, symptoms can still occur despite appropriate intervention. This can get your loved one down and even lead them to become a danger to themselves or others.

Thus, it becomes important for your loved one to learn about how they want to be treated and how to advocate for the type of treatment they need at a particular time. A good resource to help them develop these skills is wellness recovery action planning. WRAP groups will teach your loved one to develop a crisis plan. Learning to plan for crisis ahead of time and to collaborate with others to learn about the best resources that are available to them is very valuable.

Thus, if psychosis does cause your loved one to become a danger to themselves or others, lean on the crisis plan they have developed to get them to where they have determined would be most fitting for them. Call 911 only when all else has failed as that is truly a last resort. Having police called can become traumatic for many people.

What Psychosis Treatment Options Are Available?

Psychosis has been around for a long time and was once blended with religion and social order in earlier epochs. Before there was oppression from the state, psychosis might have caused social status to elevate. It is only when there is a great deal of oppression and a medicalized view of psychosis that treatment starts to be a negative thing. Now, it can be hard to find treatment for psychosis that doesn’t involve warehousing and suffering in the United States.

In some situations, anti-psychotic medication can help control the symptoms. Still even while on medication it often takes a lot of hard work to get to the point where voices, other hallucinations, or “delusions” disappear.  Additionally, when there is miscommunication between the psychiatrist and the patient, or violence during incarceration, there is the problem of overmedication. When there is too much medication there is often sedation which adds to the negative symptoms of schizophrenia. When used properly, I believe medication can function as a tool for some people. Even so, some people may be able to taper off their medication at some point.

I have said a lot about treatment that is negative. If your loved one becomes a threat to themselves or others, temporary inpatient treatment may be a resource you must use.  Still, I discourage people from thinking that long term psychiatric incarceration is a reasonable option. Too often, long- term incarceration just confines people and fails to address any issues. Many long-term facilities just train your loved ones to accept warehousing. That said, there may be times when long term treatment beats other warehousing circumstances or homelessness.

Many people don’t believe therapy is helpful when people are in psychosis. To counter this argument, cognitive behavioral therapy for psychosis has been set up and is thought to be a best practice and can be used to help build the skills and knowledge necessary to cope with psychosis.

I believe that individual, family, and group therapy can all be beneficial. However, it’s important to remember that not everyone responds to therapy treatments the same way, and different styles may need to be tested to find the most effective styles for your loved one.

I believe that hearing voices network groups are a great potential resource for people who experience psychosis. From fifteen years of running these groups in an outpatient program, I have learned to identify four areas of treatment off which I base my work.

First, learning to tell your story and articulate the experiences associated with your internal process in groups or with another individual helps a person be more mindful and aware that other people have similar experiences and that there are other explanations for what is going on with you that exist. This can take a while because many people are taught through hospitalization that it is not safe to talk about their experiences with anyone.

Two, collaborating with others and learning about new explanations for these experiences can help one become more flexible in how they make meaning of their experiences. This can help people realize when they are getting tricked and how to avoid getting tricked into negative self-fulfilling prophesies when they get stigmatized.

Three, behaving against your negative symptoms or emotions and working toward social rehabilitation is likewise very important. To do this it is important to learn about aspects of treatment you have found traumatic and learn to accept limits to which you can share your internal experiences with others outside of groups and practice social skills toward social functioning in the right contexts. For many people these contexts need to be work related, but not for everyone.

Four, as people start to improve, they start to recognize the existence of stigma. I believe it becomes important to work against internalized stigma through checking your thinking using cognitive therapy. I believe that stigma and being treated badly makes people with psychosis think poorly about themselves. I consider rational thinking and cognitive therapy to be a tool, much like medication is a tool, that might help.

Choose a Specialized Psychotherapist for Psychosis Help

If your loved one is suffering from psychosis, they may be very afraid of coming for help or even interacting with other people for fear of being invalidated and mistreated. Still, there is a lot of hope for your loved one and it is important to highlight the positive things that your loved one does do. If you are looking for individual therapy I can help.

I am a psychotherapist in California with over 25 years of experience. I offer treatment for psychosis across diagnostic categories. I also offer treatment for trauma, anxiety, depression, auditory hallucinations, and substance abuse. If you know someone needing therapeutic support, contact Tim here.

The post How to Deal with Psychosis, Help Loved Ones Deal With It appeared first on Redefining "Psychosis".

What Is Psychosis?

Psychosis is the name given to a wide range of mental ailments categorized by periods in which someone loses touch with reality. These episodes are difficult to process because they’re so convincing. Someone in the middle of a psychotic episode is unable to differentiate what they are experiencing from consensus reality.

Did you know that somewhere around 3% of Americans will experience a psychotic episode in their lifetime? That’s around 10 million people! Still when one considers that one in every ten people hears voices worldwide, this 3% estimate seems conservative. 

Psychosis is much more common than many people think or would like to believe. As with other taboo DSM classifications of yesteryear. like homosexuality or drapetomania, schizophrenia is so badly stigmatized that related experiences go widely underreported.  

If you’re curious to learn more or have ever asked yourself, “What is psychosis?” You’re in the right place. Read on to find out more!

What is Psychosis?

Psychosis is the word used to describe a mental health problem that causes people to perceive things differently from how they are. The two main examples of psychosis are categorized by episodes of hallucination and delusion. Often, these are experienced at the same time. 

Hallucinations are defined by sensing things that don’t exist. This includes sights, sounds, feels, and smells. Hearing voices is a common hallucination reported by and observed in people suffering from psychosis. Delusions are when someone believes things that aren’t true, something that seems baseless and illogical.

At times delusions and hallucinations make sufferers act in peculiar manners as they react to things without a basis in reality. Paranoid thoughts involving friends and family are common examples of delusion. Beliefs of intricate plots being drawn against them and unfounded suspicions are good examples.

Psychosis Treatments

Treatments for the many forms of psychosis need an individually tailored approach depending on the needs of the patient. Antipsychotic medication may help relieve some experiences that trigger psychosis, but there’s no magic pill. If pharmaceutical aid is proven effective for the patient, they have to deal with negative side effects. Long term use of antipsychotics is often imposed while health risks are not considered.

Psychological therapy is a proven treatment for helping a patient overcome their challenges. Speaking with hopeful professionals who are knowledgeable in specific strategies is helpful. Speaking to professionals who simply refer the person to the hospital is not and say they are trained to work with such conditions is not.

Cognitive behavior therapy (CBT) is thought to be helpful with people dealing with schizophrenia. I believe CBT helps reduce internalized stigma and is a valuable tool at times. Family sessions have also proven to be effective in reducing the need for extended stays in the hospital. Teaching family members to care for and understand the plight of their loved ones allows for significant aid from the comfort of home.

Reducing reliance on unfamiliar places and people helps to lower the stress of the patient in general, but limiting the stress too much also reduces the individuals’ ability to function. If the person in question continues to have severe psychotic episodes, having a structure they can adhere to like a job or a program where they volunteer to work with others often helps maintain and build on functioning.

Psychosis treatments aren’t guaranteed to be effective. The nature of the condition is difficult to understand and there is so much stigma, discrimination, and abuse that people in a break endure, that there remain people who fail to thrive. Many attempts and different approaches are often necessary to see a positive effect.

Causes of Psychosis

Psychosis isn’t recognized as a mental health condition in and of itself. It’s seen in people who are struggling with a diagnosed mental health condition in conjunction with other symptoms specific to it.

Psychosis is a common symptom of schizophrenia, a condition that causes a wide range of debilitating mental effects.

The question of ‘What is psychosis?’ often leads people to explore other conditions where psychosis is a foundational symptom. In the DSMV, there are 30 different diagnoses with features of psychosis in them. This helps further the understanding of psychosis in a general sense.

Schizophrenia is a brain disorder that disrupts healthy thought patterns due to delusions. Traditionally. When someone has a psychotic break, they are often thought to have schizophrenia. However, bipolar disorders that cause feelings of intense despair or mania can also trigger a psychotic episode. 

Causes of psychosis are specific to the individual but are sometimes thought to be a response to traumatic experiences. Changes in the physical makeup of brain structure can make us perceive the world in unexpected ways.

Delusion and hallucination are relatively commonplace after sustaining serious brain trauma. Tumors and the abnormal growth of brain tissue are often observed in people suffering from symptoms of psychosis.

I believe psychosis results from a collection of experiences that trigger thought patterns. Some of these experiences like intuitions, dreams, or reads on interpersonal energy are common to everybody. 

Signs of Psychosis

Signs of psychosis are relatively simple to spot in someone suffering from a severe psychotic episode. Anyone who insists on an alternate unobservable version of reality is most likely having a psychotic break.

We’re quite in tune with a standard shared version of reality, and when someone deviates, it will usually be obvious.

Someone interacting with people, sights, sounds, and voices that don’t exist is a strong sign they’re suffering from psychosis. If they’re experiencing fear and paranoia without an obvious cause, these are also strong indications of psychosis.

Indications of psychosis can be subtle and difficult to diagnose in some people. Someone who seems outwardly calm and collected might be suffering considerable internal turmoil. Losing focus and freezing up may indicate they’re dealing with their psychosis inwardly.

Not everyone exhibits wild and sudden changes in demeanor or emotion. Some people suffer for years without ever being able to draw a line between their delusions and reality. If you suspect someone to be suffering from psychosis, you can contact a professional and ask their opinion on how best to proceed.

Help for Psychosis

Fortunately for sufferers of psychosis and mental issues that cause it to be a regular occurrence in their lives, help exists. A wide array of medical aid is available in the form of therapy, prescription medicine, peer support, employment support and other professional therapeutic aid.

Before help for psychosis can be found and implemented to the best effect, a consultation must be made to tackle the issue. It’s not as simple as prescribing a blanket medication or therapy, as every individual has different needs.

If you enjoyed this article, “What is psychosis?,” don’t hesitate to reach out. We’d love to hear from you.

The post What Is Psychosis? appeared first on Redefining "Psychosis".

My Plans Moving Forward . . .To Evade the Illuminati

Okay so creating an online course these days is quite the rage these days. Every entrepreneur and their cousin are out to sell you an online course. Therapists are becoming coaches and selling courses so they don’t get trapped in the therapy mill. I must say that fifteen years ago when I started work on building my course, I didn’t anticipate all this rage. I didn’t know about creating funnels and email campaigns and perfecting an evergreen project that I could sell. I didn’t know about testing it out on my audience and making sure that it will sell etcetera.

Writing my award-winning memoir has taught me the importance of marketing. It never occurred to me during all those rewrites that I would get to the end of the project and find that no one cared about me, my story, or my awards. I did what I could to build a writing platform so I could market the book in spite of this. I blogged for years, built my website blogged three more years, and the results: maybe three books sold off my website.

It’s true my frustration about the futility of this effort did start to make it into a few of my blog posts. I recognized that I was feeling negative and putting out stuff that was attracting nothing but negative. I retreated and licked my wounds and finished my course.

Now thanks to Facebook I am learning that I need to go through a process so I can create a business so that I can sell my course.

I remember fondly days when I was writing my book and learning to present my training. There were some good times.

I remember one year I stood in front of an attentive crowd at a CASRA Spring Conference. I was explaining how it had seemed to me like the traffic lights were getting messed with to set me up to be late to the conference. I was explaining that I had to stay cool and not become emotionally impacted by these thoughts as I had in the past when I thought I was being harassed by the Italian Mafia. Right when I said the word mafia, smoke started filling the room. I recognized this as the likely work of a smoke bomb in the air conditioning vents. The hotel workers suggested maybe the air conditioning was broken. The room was forced to evacuate, and a woman looked at me through the smoke and said that that was real smoke coming out of the vents. Believe it or not, I knew that the smoke was real! I laughed.

Determined to finish the presentation we found a new room and got through what I had prepared. In fact, I got very good feedback for the hour and a half presentations year after year. I learned that I had to get comfortable and be myself in front of the crowd.

The online course I have created is approximately twelve hours. I plan to run it a few times with about ten participants. I hope to be able to do this over the summer.

Because there are a lot of moving parts to creating an evergreen course that will sell, I am shopping for a coach who can tell me what I have to do. It seems key to finally building an online audience so the same thing that happened with my book does not repeat itself. I know I am needing to find a way to get more support on social media. That might mean having to come out of my shell a bit more because blogging didn’t work. So I have to get someone to teach me how to do this.

January 25th at 3:32 am I got messaged on messenger by someone I must have accidently friended. It reads”

 

Illuminati Invitation

Based on the membership criterion of the illuminati,

we find you are of great interest in possession of a good

manual dexterity and academic proficiency. With this,

we look at you as the class that will be the platform for

which you stand to meet the wealthy people who can raise you

to wealth, power, fame, and glory. I strongly

recommend that you join us in the illuminati.

Joining us you become wealthy and live the life you desire.

Do you accept the offer?

 

Now if you are thinking I don’t have to hire a coach and jump through internet hoops to get my presentation out there, then you don’t know me very well. A month and a day after I received this message, this man named Larke followed up and I still haven’t answered.

Sure, one could argue, all I really must do is keep quiet and accept wealth and power and find out if the illuminati is real by having a conversation with Larke. But clearly, I believe in transparency and no secrets. I have tried to avoid belonging to secret societies as much as possible. Being part of a treatment team at my job is bad enough. Joining the illuminati takes belonging to a secret society to a new level.

Sure, I want people to read and consider what I have to say, but I feel I have been harassed by secret societies in the past, I don’t want to join that which nearly broke me and ruined my life. I was told that I had schizophrenia, would need treatment the rest of my life, and that I could not be cured. I believe I lived the life of a modern-day indentured servant, and no one cared or believed that what I went through was real. I wrote a book that got some good reviews, but still people didn’t care. Many people I knew judged me. I guess many prefer to use words like sick or crazy to describe me.

So I choose to ignore the Facebook message I got from a man named Larke. I just keep trying to do what I believe is needed to get my work out there. But all this effort suffering and hurt that I have gone through feeling invisible continues because I am stubborn. The whole thing makes me feel the world is fake and stupid.

To learn more about my course click here.

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Transforming my Energy Toward Course Creation

It has been a long time since I have written a blog post. I turned my efforts away from creative essays and introspective exploration. Instead, I focused on creating a 12-16 hour Master Class entitled: Redefining “Psychosis:” A Cultural Approach to Working with Madness, A Roadmap to the Rabbit Hole.

Time away from weekly writing has been important for me as I was not gaining an audience or selling many books. I’ll admit a sense of frustration was entering into my work. It’s not a good look writing about how jaded you feel. In working on the Masterclass, I had plans to present it, but those plans fell through when I couldn’t agree on a contract with the agency with which I was working. I decided to complete the project and apply to present the class through PESI. I am aware this is a long shot, but completion made sense. This way I am prepared if any opportunity arises.

I have been finding my Facebook feed is full of advertisements about creating online courses. I have started to explore and research what would be needed to convert my knowledge and skills into something that is concise and that could offer me a return on investment. I figure I could market through the infrastructure I have built up on my website.

I think my greatest challenge is to tilt my perspective towards providers who work with people who are in special message crisis.

I remember starting out in social work while I was in graduate school. I didn’t sign up for the job because I wanted to do harm, I just listened to my supervisors and tried to make it. I just didn’t fully understand what the people I was trying to help were going through. I didn’t want to know that I was doing everything wrong, but I did want to have good relationships with the people with whom I was working.

Some preliminary web searches has connected me with the work of Ron Unger out of Oregon and I see he has sold a number of online courses in my field.

I also have been interviewed by Charles Shaw over the course of a few years. It is my understanding that in his new book there will be a chapter about me. Working with Charles was interesting. I had the opportunity review his work and to see myself through Charles’ eyes. Charles is a writer who has been able to gain an audience. My hope is that I too can build an audience that can help change the public’s perception of “psychosis” if I can adjust what I am doing and learn how to teach online.

I am currently on transit from a visit back east to see my parents. I am in the Denver Airport and am sitting in a crowd of people who are waiting to go on a plane to Wichita, Kansas. During the visit with my father, we commiserated a little. He has also struggled for years to have his voice influence public policy with regards to ecology and economics. He eighty-one years old and grieving that he doesn’t have the influence he would like. I have listened to him talk for years and he has good ideas about save lives and the planet and address the economic income gap. He has struggled to be satisfied with his gains and to accept the fact that his ideas aren’t popular in the mainstream.

I am working on having more compassion for both of us much as I need to build compassion for the people who don’t want to listen to us. None of us are perfect. Fighting against mainstream views takes compassion and patience even when you feel like your efforts are going nowhere. I had a great time writing my memoir and it won awards for being well written. I haven’t been able to attract a large audience as a blogger or writer but am still working to find that voice that people want to hear. I love writing, but also recognize that currently YouTube and videos attract a larger audience. If people want to learn something it is important to meet them where they are at. If people like my courses, maybe they will also purchase my book.

At this point, I have a meeting with an online course guru to see if I can get help marketing and producing a digital product. I am not sure what it will bring, but I will keep readers posted.

Click here to learn about my Master Class!

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Is Telehealth The Future Of Psychotherapy?

By Monica Vandyke

Even though the COVID-19 pandemic seems to be slowly fading into the background, safety precautions and physical distancing remain priorities for many. And throughout the pandemic, these priorities have helped to fuel the remarkable rise of telehealth –– with one report at PR Newswire citing a single Medicare provider that saw an increase of as much as 2000% in telehealth consultations alone. That’s a remarkable number, but it indicates just how thoroughly remote healthcare has been embraced, which in turn speaks to why it’s likely to stick around.

Make no mistake, this is likely to be the case where psychiatric and mental health matters are concerned as well. Just last spring, Medpage Today referred to psychotherapy as the “most common telehealth procedure, which means quite clearly that when the pandemic is finally behind us, and telehealth is still being practiced, psychotherapy patients will be among those benefiting.

Here, we’ll take a closer look at what exactly that means.

What Telehealth in Psychotherapy Looks Like

With regard to psychotherapy, telehealth is a way for people to have medical consultations with therapists, seeking advice and feedback via phone or video chat. Initially, it may seem strange to have a therapy session on a mobile device or computer if you are used to having face-to-face meetings. But many people who have tried telehealth find the experience to be very safe (particularly in light of the pandemic) and satisfyingly convenient. So long as a patient has an internet connection and a proper electronic device, they can see their therapist virtually from anywhere at an agreed-upon time.

While there are many advantages to telehealth, however there are also some challenges. For example, it is true that some mental health patients in particular might miss the empathy and compassion that are more easily conveyed through face-to-face, in-person interaction. However, with regard to issues like this it is important to note that the future of telehealth –– which we’ll speak to further below –– is very unlikely to remove the option of in-person consultation for most patients.

Why Telehealth is Likely to Stick Around

Whether or not telehealth is likely to stick around in general has become a common question of late. The online health resource SymptomFind took this question on in detail in a recent post, and concluded quite simply that most care that doesn’t require detailed exams or diagnostic testing is “optimal” for telemedicine. Virtual appointments, in other words, are not just practical and convenient because of the pandemic, but are actually ideal for the average check-in.

It is also the case, as has been indicated in numerous surveys, that the majority of people who have tried telehealth find it to be a very effective way of engaging with therapists. The fact is, as much as many patients value in-person care, most place a premium on convenience. If a given appointment doesn’t require any kind of physical examination or assessment, a patient is generally unlikely to prefer going out of their way for an in-person appointment if virtual care is an option. And given that so much of psychotherapy does come down to conversation and verbal assessment –– rather than physical examination –– these factors may be even more relevant in this specific area of care.

What the Future Looks Like

As we look to the future, the current trend tells us that telehealth must be available as an option for all future clients. Psychotherapists will continue to adapt to the trend as needed. However, that does not mean a slow and steady push ever forward toward complete telehealth. Rather, as with other areas of healthcare, it will mean a push toward hybrid care.

This is construct we’re hearing more and more about, which essentially describes what we’ve already come to see during the pandemic. Patients will have the primary option of scheduling telehealth appointments –– perhaps on a regular, recurring schedule in some psychotherapy situations. However, care plans will also provide for the scheduling of in-person appointments –– say, if a certain assessment or test is needed, or if either the therapist or the patient deems an in-person meeting to be necessary.

All things considered, telehealth has proven to be a valuable tool for psychotherapists and patients alike. This method of care connects patients with their therapists for their continued care –– a service that would otherwise not have been possible in the darkest days of the pandemic. Moving forward, it will make care plans more flexible and convenient, and may even help more patients to seek care when they would not otherwise do so.

Thank you for reading, and for more content on psychotherapy services, training, and a range of related topics, please visit us here at Tim Dreby again!

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Seven Styles of Narcissistic Abuse Behind A “Schizophrenia” Label:

I am a white male from families that mostly owned property or had social power. I have to say one of the most meaningful projects of my life has been to overcome my narcissistic background.

I once had a shrink that told me that my “paranoia” was like reverse narcissism. I really wasn’t as bad as I thought I was.

At the time, I was working twelve-hour days of physical labor, (four hours of it was a sweaty bike commute.)  I was bringing home 900$ a month and paying $955 dollars a month in rent. I was coming back from a psychiatric hospitalization and battling housing insecurity with some financial help. I had many internalized parts that judged myself in narcissistic manners. These parts were reinforced by the attitudes of the few people I was in contact with at the time including the shrink.

The problem was that just about everyone I knew actually judged me worse than I judged myself. Within five minutes of talking to me they presumed I was delusional. To me that meant I was schizophrenic and that I would spend the rest of my life in hospitals. To many it meant I was no longer friend material.

Now over twenty years later, I feel like I am fighting narcissism and slander in most communities with which I come into contact. The only community that I don’t feel that way about is the community that subjects themselves to psychiatric treatment in the hospital where I work. In other communities I feel ostracized.

One might think a person like me could find social comfort via affiliating with communities that stand in resistance to narcissistic abuse. What I find is that the power structure of some of these communities often excludes me. Sometimes I feel excluded for good reasons, and sometimes I feel excluded for bad ones.

I tend to view power in society as narcissistic and unjust. Ultimately, I choose to think all these styles of narcissism I have endured are here to help me overcome my own sense of narcissism. I have learned to lean on a higher power to ease my desperate moments. I remember that the privilege I was raised in was the result of abuse of others. I choose to continue to learn ways that narcissism is wrong.

Today I intend to identify seven styles of narcissism that have tended to lead to abuse in my journey. In many people’s eyes, these styles vanish with the use of a label that explains all that I have gone through as being a schizophrenic medical condition.

I write imagining that the styles of narcissism I identify are such that others might relate to in a variety of ways. Each style is something that can turn chronically normal caring people into judgmental and exploitive narcissists.

I come from a culture that has used genocide and slavery to advance its power so it is number one. It’s arguable that this gives our citizens a natural tendency to think they are better than others. We always hear about American casualties in armed conflicts.

It strikes me that this is important now that narcistic abuse and gaslighting is starting to be a focus of psychotherapy practice. I hope to use aspects of my personal journey to help challenge narcissistic judgements and decrease the things that divide us.

Style Number 1:  Exploitation Resulting from Unrealized Sexual Abuse:

Somehow, I developed a tendency to be hypervigilant regarding sexual intentions of others and to dissociate when things get uncomfortable. Since an early age, I remember having distressing feelings that I do not understand. I believe that in my case this has resulted in complex trauma or interpersonal struggles with others.

My teacher in kindergarten observed that I didn’t do well socially.

Back when I took baths with my sister I would play with my penis and ignore my mom’s nagging that I needed to stop. One time, exasperated that I would not listen to her, she sketched me with my hand in my crotch.  This was effective in getting me to stop but also resulted in shame.

I shunned all things associated with masturbation at an early age. I used to explain this to other kids on the playground, unaware that there was anything unusual about this.

Latency was a very serious thing. I remember vowing to my best friend in second grade that I would never to have a girlfriend.

In the next year or so I was coerced into taking a bath with a family friend’s daughter and when I was groped. I dissociated and ended up eating a moth ball necessitating poison control to be called. This was a detail I never remembered until I was writing my memoir in my mid-forties. I showered in my shorts for a year after the incident with the family friend without ever understanding why.

During my first year at sleep away camp at age eleven, I was terrified by the expectation that we would be okay with skinny dipping.

In sixth grade I refused to dance with girls and repeated things my mother told me about sixth graders not being old enough to dance with each other.

Being different in this way led to a lot of teasing and shame. Not only is the act of sexual abuse narcissistic, but the social response to people who are easily shamed is also.

I now believe that I was sexually abused by a family friend at age three. Not remembering this made latency and the trouble I got into with my mother a very serious thing.

My father had an affair and eventually divorced my mother when I was fifteen. My mother was very hurt and rebelled by having polyamorous relations with other men. Thus, when I was sixteen and reaching a late puberty, I had a hard time forgiving my mother for this and developed lasting resentments. My failure to have empathy for my mother was rather extreme.

As Pete Walker suggests in his book Complex Trauma: from Surviving to Thriving, with early abuse “the superego morphs into a totalitarian critic that trumps the development of a healthy ego.” (26). In my experience, having a strong sense of conscientiousness can result in bullying or the failure to thrive as a social being.

I repeatedly struggled to have empathy for others when they engage in corruption.

Also, one summer during my teens, I believe I witnessed a brother rape his sister. I remember that they were skinny dipping. I have other vague and foggy memories of the deed. They are not attached to my other memories of the evening. I do know that the sister ended up having dissociative identity disorder. I remember running in absolute terror and feeling like a terrible coward.

In short, child sexual abuse may lead to complex trauma in relationships with others. Other kids always seemed to target and believe they were better than me and this reinforced my shame. This happened in a host of settings. I later developed mental health symptoms and food addictions.

Style Number 2: Being Underestimated and Misunderstood with A Neurodevelopmental “Disorder”

Diagnoses such as autism, dyslexia, attention deficit or obsessive compulsive are now being considered to be developmental trauma. I was not diagnosed with attention deficit and dyslexia until I was in graduate school. While it is possible for many with the right interventions to maintain their school performance, I never received extra support or understood why I struggled so much.

In simple terms, these kinds of learning challenges mean that some areas of the IQ may be high, while others are low. Or perhaps its easier to understand that some areas are more utilized and higher while others remain less utilized and fail to develop. Fluctuations in abilities as such make learning more challenging.

In contrast, people tend to associate neurodevelopmental struggles with a resource room, or ultimately segregated special education classes. In its most extreme form, segregated severely emotionally disturbed schools, with point systems may seem to prep smart students more for prison than it preps them for acquiring job related skills. These kinds of consequences and associations to these consequences can make a neurodivergent child be treated like they are less than.

Indicators of these kinds or struggles that I experienced were speech impediments, anxiety related to school attendance, getting teased, tendency to befriend only older or young playmates, and poor spelling. I nearly wasn’t allowed entrance into the school where my parents taught because I didn’t use the scissors like everyone else.

Some teachers or parents who see these emerging patterns of behavior may become critical and fail to connect with the neurodivergent student. Or they may not understand the struggle and set unfair expectations rife with microaggressions and high expectations. Thus, being misunderstood or not properly trained by the teacher may set up the sense that other kids are better.

In my case, I was extremely slow in accomplishing tasks, but I worked to compensate and brought home good grades. My father presumed my slowness was laziness and tried to force me to work harder. When I couldn’t sleep at night for a year, he intervened by taking a working vacation in which we worked physically for sixteen-hour days. I did sleep. It was a solution.

When you get older, people do intellectual assessments of you based on the college you attend, interpersonal skills, the company you keep and your job. As the reader will see, I haven’t lived my life to pass these intellectual assessment tests. Many people narcissistically judge misfits, underestimate, or ostracize them.

In high school, I spent dozens of hours perfecting a fifteen-page story and got a B. My college essay that I incessantly rewrote nearly got me kicked out of the school convincing the school psychologist that I really was suicidal. I poured my heart into my Poetry notebook which only earned me a B because it was too depressing. I wrote a twenty-five-page essay on Tibetan Buddhism with 60 references that went unrecognized.

For a variety of reasons that will become clearer, I chose not to go to a college in which the same thing would happen to me all over again. I did the work without being in community. It is arguable that this further amplified my neurodevelopmental differences.

Style Number 3: Facing Class Superiority with a Complicated Class Identity

My first experience of class came from comparing things like toys, houses, violence and vacations to those of my peers. I developed awareness of the stark contrast between rich and poor in the early years of my life. I noticed many who are well-to-do develop notions that they are better than other people and they fail to realize that other people may be smarter or stronger than them.

When I was a child, I seemed to have a raw deal. My parents had private school teacher salaries which are not all that impressive and they could not afford to keep up with the Joneses. Though they bought a house in one of the wealthiest Philadelphia suburbs, I did not understand it was a wealthy district. The house we lived in was old and taken care of by my father who was a do-it-yourselfer. Therefore, I grew up with a sense of depravity when I compared myself to my private school friends.

In contrast, in the summer we went into an impoverished rural community where we owned cottages and property. I compared what I had to what the other kids had and I found myself embarrassingly lucky.

I would notice that local kids would act very virtuous in front of me when my family hired their parents. That part of my family had been lumbar barons and the town had been built around the lumbar company. Thus, we were on remnants of a very unjust system.

One time, I challenged this fake niceness I was noticing and I found my virtuous friend to be capable of atrocious behavior that went beyond that which I was comfortable. Thus, I realized that many of my peers in that rural town had to fake it in front of me because their lives depended on this.

Of course, there was always an occasional kid who would urinate on me when I was three or try to fight me when I was thirteen. I was not embittered by these experiences. I could always understand how these acting out kids felt because I knew what it was like to have a raw deal in comparison to the suburban kids with whom I grew up.

At one point in my preadolescence, we rented out a property to a welfare family. The kids had fancy dirt bikes. For me, dirt bikes were a no-no. They were just too expensive for me to have one allotted to me. It was confusing. My father explained that in his experience growing up, scholarship students often had better things than he had. It was confusing but it was reality.

The welfare kids would give you the shirts off their backs because they liked giving. I could use their dirt bikes as much as I wanted. Then, my father exclaimed that they worked a lot harder than me. It was hard not to feel they were better than me at all turns. Plus, they knew how to have wild and unruly fun, unfettered by adult intervention. I liked them a lot and wanted to be like them.

Meanwhile, back in junior high, my cohorts were having a field day on me perhaps in part because I was not allowed to wear name brand clothes. I didn’t like being teased by spoiled kids and I fought back by acting out in odd manners. That was a problem for the teachers who witnessed this. I was sent to a shrink.

When the shrink met with my parents because I said they would not buy me name brand clothes, I learned that it was my fault I was not wearing the name brand clothes. The only good part about being blamed for something that was not in my control was that was I got to go shopping. The thing was I still learned that I was better off when I bought cheaper imitation brands. I stopped fighting and tried to get along for a spell.

The issue of income disparities and the superiority of the fortunate is complicated. The norms of rich people exclude people who don’t fit in. The norms of poor people seemed to me to be more open, even though in my case, the rural poor were forced to deal with me. I did not understand the violence that often comes with poverty due to the reality of the U.S. black market.

Ultimately, disparities in income have a tendency to make some people think they are better than you. The haves hate the have-nots is how many people understand this. False notions of superiority get spread throughout the culture based on this.

And yet the realities of crime are a great equalizer. Crime may have been what afforded those welfare kids with fancy dirt bikes. When crime, drugs, and corruption enter into the picture, things get a wee bit complicated.

Style Number 4: Judging those who Fail to Regulate Addictions

Around the time I was exposed to the reality of substance abuse, I refused to be influenced by peer pressure like everyone else. I did not feel ready to use and I didn’t like the way I felt drinking alcohol. My father drank in a way that often made me uncomfortable and I didn’t want to be like him when I was drunk. The result was that my social struggles were exacerbated. I did not associate my need to relax with socializing and with alcohol like everyone else did. I secretly became obsessed with eating.

It was the summer of 1988 and I was in a work camp in Orangewalk, Belize. My peers did notice my obsession with getting enough food and often made fun of me about how much I ate. Unlike them I was working many physical jobs all day under the Caribbean sun. They were sleeping after drinking ten or twelve beers the night before. I would go out with them but retire as soon as I could so I could work. Thus, when they saw me craving food, they made fun of me.

The next year I did not fight the temptation to drink and socialize when I was buried in school work, I fought the temptation to eat. I did this twice a day for lunch and dinner. Meanwhile with my undiagnosed learning disabilities I worked late into each and every evening trying to keep up and perform at the level I was capable of performing.

I lost my position as a starter for the varsity soccer team because my speed went down. I just didn’t have the gumption to chase the ball the way I used to. I still felt that I had to get a control of my appetite. I planned and organized social service events for the school community during the lunch hour. I started lifting weights and running long distances after soccer was over. I continued to sleep four hours a night to complete all my homework. And I started counting calories. By the summer I was admitted to the psychiatric hospital at 6’1”, 103 lbs.

The following year I was in and out of the psychiatric hospital and barely completed the year to earn my high school diploma. I moved in with a friend to get away from my parents. All the service work I had done the year before was credited to my colleague. I took to writing, but my best efforts failed to deliver the results I wanted in terms of grades or awards. I became invisible and my classmates shunned me. I skipped graduation night for a lifeguard course so I could move to a Summer Camp. I left the suburbs and my life at a private school and never looked back.

My peers thought I was bulimic because they always saw me eating cookies for lunch. In my opinion they were so wrong about me because they believed the gossip that emerged from my parents. I resisted their efforts to fatten me up in the first hospitalization they sent me to by vomiting in the hospital trash cans.

As I mentioned earlier, I increased my writing efforts as an outlet for my pain and my grades decreased.

I would want nothing to do with the school or my peers by the time I graduated. I followed a twenty-five-year-old old girlfriend to a local commuter college to rebel. I blamed the school and my peers just like they appeared to blame me.

What I failed to realize was that I became addicted to hunger, like many addicts get addicted to their substance of choice. It is expected that people my age start using substances and regulating themselves so they can still perform. I failed to do this. I know what they all concluded about me. It is what they conclude about addicts who fail to keep up their school work. I was weak. I was not worth their time.

It is not until I have lived many years and looked back that I realized the sense of narcissism in the private school community got expounded by my public display of addiction.

Style Number 5: Impact of Racial Abuse

As a white person, I cannot do justice to the narcissism associated with race in this country. I have not lived it the way people of color do.

I leave inner-city communities of color and can still look like I belong in the suburbs. I do not face micro-aggressive eyeballs everywhere I turn and people who fear that I will become violent.  In fact, I know the white world pretty well having grown up in it. I may experience a pinch of imposter’s syndrome when I try to connect in suburban contexts, but it does not take away the fact that I grew up there.

I immersed myself in a black and brown inner-city community in college. I worked at a summer camp at the Camden New Jersey YMCA in which I was the only white person. I contrasted the facilities with those in which I grew up. A lot of those kids at the YMCA had middle class families that could afford the tuition and yet they had to accept the roach filled facilities.

As middle-class white kids we were taken out to nature and had other activities to enjoy.

Then, I worked at a Korean run deli with neighborhood coworkers for three years including two summers. Since that time, I have maintained ties with communities of color through years of working in social work. I have worked my current job for twenty years at a majority African American community.

My first apartment was roach infested and I had to carefully and respectfully connect with neighborhood people to get it. I used to make the managers dinner at the Deli to even be considered for the apartment. I needed to let my coworker con me into driving him to his connects house to cop. I needed to be friendly with the owners of the drug complex across the street from my complex. Then, when I proved to others that I was a safe resource, I saw how exploitive the police were.

Especially, I learned about how the vice squad were the real bad guys. I never went to a single college party with drugs in it and yet the vice squad harassed me on one occasion telling me, “You can’t hustle a hustler.”

Yes, you can when you have no hustle.

When the university career office suggested for me a career in law enforcement, it made me cackle and feel my intelligence was being insulted.

Bearing witness to the decisions that the youth who lived on the block were faced with also had an impact. They had to work to help their family out as opposed to me who was only worried about myself. My perspective on white America did change and I was angry with people who weren’t dealing with roach infestation. Seeing one of my younger coworkers leave the job to sell crack made me really sad because I knew the danger and the challenges that he would be facing. One day I would face the same danger.

Thirty years later, I still learns lessons about the impact of race on a regular basis and I still am aware that I am racist and am liable to offend others from time to time with my cultural manners.

Europeans invaded this country and brought with them three centuries of slavery and genocide. The concept of manifest destiny caused native Americans to be killed and segregated on reservations. Three centuries of slavery was horrifically narcissistic and degrading. Then, Jim Crow laws were historically so tilted against black and brown communities, it kept them segregated and lynched for a century. And still with zoning, gerrymandering, employment bias, immigration and drug laws definitely in effect, there is a disproportionate representation of black and brown people in jails and the prison system. Skin color is often associated with stereotypes and incarceration and fills many people overtly narcissistic with implicit bias

When I came in off the streets to a mental institute and was observed on an evaluation unit, they determined that I was schizotypal personality for making the same kinds of interpretations of power in the Rorschach that I am making in this blog post. I was not influenced by the cultures I had been exposed to: the rural poor, the suburban mainstream and urban people of color; I was clinically odd. I was started on antipsychotic medication.

Style Number 6: Extending Unequal Pay for Unskilled Labor

I grew up in the throes of the postindustrial revolution when the service economy started to set up very high degree of income disparity via making many jobs so low pay that people who worked them could no longer afford the American dream.

Service work makes sense if it is carried out by young, housed individuals who are looking for a little income as they move through school. It may teach people a work ethic and may motivate them to get skills in school that will enable them to get better salaried work.

As I grew up, there were some people from wealthy families who never had to learn how challenging service work can be. I had witnessed a lot of people take it for granted. There are people who start work negotiating good salaries that can sustain families without understanding how hard it is for people in that sector of the economy.

Working these jobs, a student can also meet and get to know people who work in this sector of the economy who don’t have it so good. Many may learn and accept that such people fall into the temptation to make fast money, yet do they see the consequences of doing this? Or perhaps they opt to use their parents’ money to get around this kind of work altogether. Some may think the work is easy and for people who aren’t as smart as they.

When I reached an independent age in which I had to balance rent with the rest of my needs, I really stared to learn how little that kind of work is respected. Additionally, when I befriended people who are in those situations I started to understand and respect the injustice.

I began service work in high school and college and it was always a means to get extra income that helped sustain me. In college I used it to pay my expenses, but I did not depend on it to sustain my rent or tuition. I had parental support for that.

When I started living independently, I always worked an extra service job to make sure my expenses were covered.

It wasn’t until I was forced back into the service economy due to my mental condition, when I really understood how difficult it was to sustain rent and independent living on so low of a salary.

Not being able to afford a car for help with transit and working forty hours a week earned me nine hundred dollars a month when my rent was nine hundred and fifty dollars a month.

I had to transport myself from an affordable location into my low paying job in a wealthy district which took four hours a day. I was doing everything in my power to survive and I couldn’t do it until I found a better salary back in social work ten months later. I never worked so hard in my life.

I found doing unskilled service work for such low pay was far more demanding than working two jobs and going to grad school which I did for almost three years. At least back then, I could afford to drive. Everyday I see people work these jobs and I do not know how they can afford to survive without family support.

I feel that people who do not understand how challenging unskilled work can be can be can easily undervalue it and treat people who struggle with it in narcissistic manners.

The shrink who made 125$ an hour presumed that because I was only making 9$ an hour that I really wasn’t working that hard. Certainly not as hard as she. She denied any level of financial exploitation from her business.

Style Number 7: Challenges that Await the Formerly Incarcerated

I was a ward of the state for three months in a state hospital where I obtained a diagnosis of schizophrenia. After the law could hold me no longer, I was streeted at a Greyhound bus depot with the remaining three thousand dollars I had in a bank account and a months-worth of medication.

I was afraid of again being followed by police and possibly by other people as I was when I was trying to cross the Canadian boarder to break a story of corruption.

My best friend had threatened me that he had the power to do me much harm if I ever betrayed him. I had been setting up services in a notorious section 8 housing authority project. There were many newspaper articles written about the project in the paper. Nobody knew that I was the off-the-record source responsible for a few of them.

My psychiatrist in the hospital refused to meet with me in spite of my requests. She moved me to the chronic unit which was a cold and dank facility. When I got very sick the staff refused to give me aspirin because she had failed to order it for me. When I was finally getting better after a severe fever, she came to see me.

“Once we had someone come here who said the FBI was following him,” she said, “and they really were following him. He hadn’t done very much but it was true they were following him.”

I did not trust her enough to ascertain that she was talking about me even though that’s what I still figure. I did trust her enough to return to taking medication because she didn’t believe the aids report that I had been sexually inappropriate the night I had begged for aspirin.

The first night I arrived in the state hospital, my roommate told me that the mafia was following me.

The girl on the unit who had a crush on me told me her father was the head of the Mexican Mafia in Montana.

Even though I should have known better, I often yelled at my parents accusing them of being mafia.

I only got beat up once. It was only by staff. They told my parents I had gotten violent when I had only tried to support another inmate who I believed to be an FBI undercover agent. He had wanted to play his guitar and I stood with him and suggested he should be allowed to do so.

I only got recruited to join one gang and I was able to refuse without any repercussions.

But nobody told me what would happen to me on the streets when I had this much exposure and knowledge about the underworld.

I did not have a parole or probation officer to drug test me or require me to get a job.

When I arrived in Fresno CA and bought a bike and paid for the rest of the month at an extended stay studio, I didn’t realize that I would be able to find a job while medicated. When I got a job, I got an apartment. It just so happened that when my meds ran out, I was unexpectedly cut from the low wage job and unable to find work. The only job I could find was a professional job as a social worker. But I was afraid that I could ruin my career. I was experiencing a great deal of harassment. I believed I was being followed again. When my bike was stolen, I believed I was being targeted.

Finally, I turned to family support. My father told me there was nothing he could do for me. But my aunt arranged for me to move close to her and she could get me a job at an Italian Delicatessen. Then she arranged family support as long as I kept that job.

I tried so hard to find work outside that Italian Deli for ten months until I was successful. The bike/train commute was really challenging.

Not everyone understands what it is like to work with young rich kids when you are in this kind of situation. I considered myself formerly incarcerated and it was hard to cool out. I finally got a car and started back on medication once I qualified for benefits.

On the bike ride to work, I would come across a man I knew from the section 8 housing complex where I worked in Seattle WA. One day he had come up to me and told me that he killed someone. I had looked at him like I was really not impressed at the time.

On the train platform he had a homemade sign that said CIA and he carried with him handcuffs.

I ignored him and worked my day.

Most days I experienced similar things that were equally bizarre and distressing. I still believe that these are tests that formerly incarcerated people are given. These kinds of oppressions are hard to measure as they are different depending on the situation.

When I finally did get a car, the police tailed me all the way to my shrink’s office which was a forty-five-minute drive. There was nobody to tell. No one who cared about anything I shared. I had to shut up and serve rich folk. I think these are examples of tests that formerly incarcerated people must endure to survive.

And everybody just presumed I was a spoiled loser who was a tax on my parents. Most of their friends, my mother told me, said they were just enabling me and I belonged in a hospital. Some of my friends just said I got into drugs.

That is the kind of narcissism formerly incarcerated people must face, I think. Many are presumed to be guilty regardless of whether they were set up or not.

False Medicalized Notions of “Psychosis”

The word schizophrenia which is based on Kraeplinian ideas about brain damage and an unfounded genetic mental illness concept, covers up lifetimes of narcissistic abuse. Quite often this concept tends to justify warehousing people and depriving them meaningful lives.

I have identified seven styles of narcissistic abuse that have been part of my life. Some of these styles are abuse I endured personally and some have been things I have seen afflict myself and others. I am aware there can be quite a variety of narcissistic behavior including physical violence of which I have not endured all that much.

Many of the styles of narcissistic abuse I have talked about are spread throughout the culture and can be quite normalized. For some, it can be easier to throw a person overboard than it is to acknowledge your own superior sense of narcissism. I do believe that often times people with privilege make the mistake of not acknowledging it.

I am aware that my view of power being a corruption of the human spirit is impacted by some of the trauma I have experienced. But I think an awful lot of people undermine the value of other people. When labels like schizophrenia or bipolar are involved, it is easier to presume that a person cannot get better than it is to give them a chance to do so. I believe that if given chances, that many more people could break through their challenges and fill their lives with meaning. But many people who endure these challenges are deemed untouchable.

Many articles I have read about how to deal with narcissism suggest setting boundaries with the narcissist, exposing the abuse by extending the concept of gaslighting that accompanies it, and halting the internalization of the messages made. Many ultimately suggest cutting off the narcissist because their methods will not change.

I think the schizophrenic who does this often is seem as having low insight into their illness. There is even a fancy word for this called agnosia. Agnosia provokes the ire of many a loved one who wants to help. Agnosia was not something I was able to overcome until I had reestablished safety and economic security. I had to work as a therapist for 6 years until I overcame it.

Unfortunately, a schizophrenic like me cannot necessarily escape from narcissistic abuse. It is hard to interact with others without seeing narcissism that can threaten my sense of self.  The best I can do is expose aspects of it in order to avoid internalizing the abuse and thinking ill of myself.

Ultimately, I feel very burdened about the amount of narcissism I view in the world that doesn’t accept me or make space for my contributions. Not all of us get to have our contributions highlighted or honored. We can continue observing and undermining narcissism so that it stops with us. Maybe that truly is as good as it gets.

The post Seven Styles of Narcissistic Abuse Behind A “Schizophrenia” Label: appeared first on Redefining "Psychosis".

Jam on Rye in the X Generation

The studio rests six stories high. On top of an old steam heater a fan drones in an open window. Clyde sleeps on a black futon that sits on the floor. He sleeps under a thick Central American bed cover his ex-girlfriend gave him.

It took a semester in the dorms, but he’d finally he managed to break up with her. It’s been a whole year now and he has established his own space. On the floor to his left there is a cup with olive oil in it.

Suddenly radio from the clock fills the room. Clyde tosses around. Time passes. He gets up and walks into his closet past kitty litter which is full with land mines of shit.

He moves through the closet and into the bathroom past the sink, which he calls the throat. He gets into the shower and cleans the shlock off his Irish wee-wee. Somehow, Clyde has no idea he is predominantly Irish.

It’s the summer. His fifty-four-hour work week is nearing an end. Today is one of his three eight- hour days. His high school friend John Randy is going to pick him up after work. They are going to catch a Phish concert at some theater in Delaware.

This morning, Clyde hits the tape deck and jams to Big Audio Dynamite in the apartment. He likes Mick Jones from the Clash and how he veers toward R+B and diversity in this music.

He attacks fruit out of his refrigerator drawers. The roaches dash over his kitchen table. He puts some water on the stove and prepares sugar-free hot chocolate. The roaches are crazy busy and of various sizes this morning.

Clyde used to have to spray one roach at a time. He’d spray for minutes and finally the roach would roll over on its back and die in the pool of chemicals left behind. A neighbor had suggested this particular black jack spray. Clyde bought it from the Sikh man’s convenience store.

As Clyde uses the spray on the table and around the kitchen area the roaches quickly die. He notices that his cat is watching him. Then he fills his hot chocolate takes a sip and spits out a roach. Once again, he has forgotten to check the clump of chocolate at the top of the cocoa before he sips.

When ready for the day, Clyde takes the stair well two stairs at a time. It takes some dexterity. Rarely does he encounter any one who comments about the noise his descending of the stairs in this manner makes.

Once out the glass doors of the decay of Pierre Apartments, he crosses Cooper Street shaking his head.

Gwendolyn is at the corner by the pay phone. This past winter every time they encountered each other they would both be underdressed for the cold. Now, in the summer, she sips beer from a bagged can. and comes at him with a masculine handshake. “What’s wrong today kid.”

Clyde loves the way Gwendolyn always inserts herself and commands respect even though he never remembers to use her name. He doesn’t suspect that she used to be a nurse. Nor does he get that she too had been put out of her house at an early age. Gwendolyn lives in the complex across the street that always has people coming in and out of it at all hours of the day.

“The roaches are bad this morning, I think the neighbors bombed their room. Does that ever happen to you?”

“Oh, we wouldn’t let there be roaches on our building.”

Clyde lives in the drug free complex and doesn’t understand. He presumes all complexes in the area have roaches.

Sure. he has studied social welfare from a suburban adjunct professor but there is still a lot about his surroundings that he doesn’t understand.

Hi professor had educated the class about what it’s like to be on welfare through assigning offensive books. Many of the students announced that they had been on welfare themselves and challenged his perspective and his choice of books. A few white women would concur with him.

One time the professor had asked the students if they gave money to the pan handlers down town.

“Why not?” he exclaimed, just in love with his power.

As clueless as his professor proved to be, Clyde doesn’t yet understand the concept of cash money even though he gets paid in it. He doesn’t imagine that when there is traffic coming in and out of a complex there is probably heaps of cash money changing hands, unlaundered money that can, with the right neighborhood connections, be used to control the roach problem. All he understands is that he gets angry when the people coming in and out of Gwendolyn’s complex call him Where’s Waldo.

Clyde crosses the parking lot for the dorms and passes a gleaming glass building before arriving at the small minimart. He is opening this morning and his coworker is closing. His boss arrives and unlocks the shutters so Clyde throws them up.

Before he turns the radio on to the local R+B radio station, he hears his boss muttering “Docy, Docy, Docy.” as he carries out his routines. Some might think he was muttering in Korean, but Clyde knows that he is remembering his mentors on the grill Doc and Ray. His boss admired Doc even though Doc cursed him to everyone he knew for taking advantage of Docs connects.

Doc had educated Clyde about how his mother had to lock him out of the house so he would learn how to fight and face the neighborhood beat down without running. Doc would smile at Clyde when he listened and lectured about exploitation. Doc had mentored his current coworker and friend, Craig G not to use the needle.

Doc knew he wasn’t getting paid enough for his long hours and left the job. Clyde had heard that when he stopped working, he went on a crack binge.

Clyde had really ended up liking Doc’s friend Ray who had been very direct with him upon first meeting. “Don’t worry Clyde, you can’t help it if you are an asshole, you were just raised that way.”

On one of Clyde’s first evenings closing the store, Ray had manipulated him to drive him to a friend’s house where he could cop. He’d only done it once. He also tested Clyde out by telling him about his sexual exploits with white women. When Clyde had continued to be cool with Ray, he would accept the role of being Clyde’s mentor on the grill. “Clyde, you have to work smarter not harder,” Ray would exclaim. Ray also gave Clyde the nickname, “Nervous Norton.”

Clyde admired Ray’s fifty-four hour a week work ethic, his wit, and how he had his weight under control. He treated Ray as a surrogate father until Ray left the job with Doc.

His boss used to build airplanes for a Korean Army, but came to America for a better life. Nobody except Clyde likes the boss because he has an educated air. Clyde likes that he is reliable and fair with his work routines. Clyde believes a part of his boss feels bad for the way he’d treated Doc and thus the muttering.

Sometimes his boss grabs his thin arms and crunches the bones and biceps. Then he says, “Clyde, don’t hesitate!” Clyde thinks he knows perfectly well what the boss is trying to communicate and accepts what his boss is getting at and yet somehow fails to give a fuck.

Clyde likes his boss a lot better than the owner. Craig G and all the neighborhood kids like the Korean owner. The owner is big, muscular, and shares his hunting hobby with all who will listen. He used to be gangster until he got married. In Asian gangs Clyde will one day learn, it is customary to leave the gang when you get married.

At first meeting, the owner had let Clyde know that he was easy to pick on. However, the owner stopped when Clyde showed sharp attitude about his compliance with handling the store Glock. All he had to do was let the owner know he wasn’t about to shoot anyone for four dollars per hour and the owner left him alone.

Clyde makes it a habit to pack those sandwiches with extra meat especially the tuna and chicken salad. The owner’s wife makes the salads and gets really angry. Clyde just ignores all the feedback.

Clyde knows that it is because of his attitude that the boss always tells him that Craig G is a better worker than him as if Clyde would care. The boss thinks such comments will curb Clyde’s behavior.

Clyde resents the fact that the stale cereal is sold for seven dollars a box. Clyde thinks the owner is leeching money out of the poor black and brown neighborhood. The deli sandwiches are the only affordable way to eat, and it is an expensive way to live. Clyde has seen the movie “Do the Right Thing!” by Spike Lee.

He contrasts the suburban houses that he imagines the owner lives in with the studio where he and other neighborhood people live. He thinks how there are no grocery stores for any of the kids who live in Camden. They have to drive thirty minutes out of the city to even get to a supermarket. He knows most of the mom-and-pop stores have high prices. Many of the kids in the city had to survive off of Ramin Pride.

As Clyde prepares the condiments for the afternoon rush, he thinks of the first kid he trained to work at the deli. This kid took him to the movies and taught him how to sneak into different theaters. When the kid finally found something that he liked, they’d settled in. The kid only lasted a few months and then went off to the crack trade. That kid was very socially skilled and knew how to connect congenially with Clyde like no other.

Still, Clyde hopes that he will make stronger connections with kids he knows from the neighborhood when they work here. He prays that they will like working with him and Craig G more than the lure of ready rock.

And yet when he hears about the white kids that commute into the city to take classes, talk poor, and boast how they steal from his boss, it somehow pisses him off worse.

Once he heard a frat brother who he’d taken a writing class with calling him out of his name, “Hey do you ever wonder how much change the panhandlers get out of Clyde Dee?”

Clyde thinks about how in reality no one asks him for change. He carries his cash in his sock with a dollar or two in his wallet. The very few occasions he’s been threatened he has donated a dollar or two to avoid a beat down.

In the store the customers treat him like he is family. One told him he was down with the brown. Another told customer told him of a local mechanic who was flaco like him. Flaco means thin in Spanish, but it’s also known as a cool nickname amongst players. The customers had a lot of love for Clyde and the community made him feel much less alone.

When commuting students like the frat boy comes down here and judge the locals according to stereotypes, it becomes hard for Clyde to befriend them.

Clyde has only made one close friend. He is ten years older and is in recovery from polysubstance abuse.

Clyde thinks his friend gets a little manic when he talks. His friend’s best friend is on the Philadelphia police force. He calls his friend a bad lieutenant in the police force. This bad lieutenant funds his friend’s education and expenses in return for under the table surveillance work. Clyde’s friend is also a writer. Some of his work, when he isn’t using vocabulary that makes him sound like Henry James, carries the tone of a mafia flick. He has introduced Clyde to many mafia flicks, but Clyde still doesn’t understand.

Even Clyde’s friend can misunderstand the neighborhood. For example, he accuses Clyde Dee and Craig G of listening to “gangster rap” in the deli. And he made a big deal once about the fact that his co-worker took care of him when he ordered a sandwich. Clyde thinks he misunderstands Craig G.

Craig G shows up after an hour once the grill and kitchen are set up. Clyde and Craig give each other the neighborhood hand shake and Craig straps on the apron the same way Clyde wears it. Craig G developed this style of wearing the apron and everyone follows suit.

Craig disappears into the bathroom and when he comes out Clyde is in the back getting a clean tub to fill with mayonnaise.  Craig chuckles, “You ever notice when its your own shit, it never stinks!”

Clyde who has never had to take a crap on that can retorts, “Oh your lucky it wasn’t me in there.”

Craig pulls out the tape Clyde loaned him and says, “You’ve got a hold of some slamming new jams on this one.”

Once last summer Craig came out of the can at closing time and showed Clyde a bone. Clyde figured he was offering to share it with Clyde.

Clyde shrugged, and expressed no interest with his face.

It was the only time Craig offered.

Craig never seemed to judge Clyde for his refusal.

Clyde went ahead and loaned him his backpack and ID so he could sneak into the University Gym. Last summer when he had acquiesced to get back with his girlfriend, Craig had given him a condom and said it’d be good if he finally got lucky. They had gone to an amusement park together, an event that made Clyde’s girlfriend exceedingly jealous.

Craig puts the BDP Sex and Violence tape in the deck and hit play. Clyde listens to the bass and familiar beat. Customers start to come in in waves and Craig and Clyde take and fill orders. Clyde ponders and learns intermittently from the lyrics . . .

Black drug dealer, you have to rise up and organize your business so that we can rise up

If you are gonna sell crack than don’t be a fool, organize your business and open up a school . . .

Or invest in a Prison, therefore you can be put in it. Everyone else did this and now they chillin

Above the law while you are under the law and still killin

Wake up my African brother, my Hispanic brother. America ain’t your mother or your father so don’t bother with right or wrong

Just check out the logic in the song . . .

In the thirties and forties the drug dealer wasn’t black; they were Jewish, Irish, Polish Italian ectcetera ectcetera, and they were making their lives a lot better . . .  

Organize, legalize, legitimize your business, remember everybody else did this

Clyde had first heard about KRS-One, the rapper, in sociology class. The black professor had said that KRS-One and Cool Moe Dee had been homeless and been able to create this music with almost no resources. Then, Craig had played his first album, Criminal Minded, at work.

Oddly, this latest album came from John Randy. KRS-One had played a concert at his white liberal college from which he dropped out. John had passed on the tape to Clyde earlier that summer. Clyde thinks it is a hell of a lot better than that Phish music John Randy is so crazy about.

This summer, Craig had borrowed his car and returned it with the gas full and invited Clyde into North Camden to ball with him and his boys. Clyde felt good about the real friendship and it was important to him.

One morning Craig G came in traumatized after hiding out all night in an abandoned building. He had been at a doughnut shop with his boys and there was some kind of confrontation. He’d had to run and hide out in an abandoned building.

Another time Craig had cut himself on the slicer and Clyde has taken him to emergency.

Clyde liked being there for Craig and it had helped them bond.

In a few years Clyde will be visiting John Randy at his parent’s shore house one night when John will get lit. Clyde will feel like John will be a bit racist, exclaiming to his father in front of his proper friends about getting picked up by a black man from Camden. Then Clyde will discover the black man is Craig G who will clearly be drubbling high on heroin.

Craig will be dating a white-women from Camden who had a scholarship to attend John and Clyde’s private school in Moorestown New Jersey.

The white girl will exclaim she can now learn all about her new boyfriend from Clyde.

She will only get the seal of his smiling lips.

It will be funny how much Clyde will realize that he’s changed

In about three years, Craig’s mentor, someone Clyde will presume to be his NA sponsor, will recognize Clyde when he will work in a Pennsauken video store and organize a reunion. Craig will have a union job and Clyde will presume he has beaten back smack. He will be so happy for him.

Craig G has a smile and general look like Tupac. He attracts a lot of women. At the amusement park they went to the year before, women kept giving him their number like he was a celebrity.

Craig is always hooking up with girls in the dorm. Even though Clyde is too shy to even think about a date, Craig always treats him respectfully. He has introduced Clyde to his main girlfriend and his best friend too. Clyde hooked them up with some real generous sandwiches.

The boss often polls the female customers about which worker in the store is most attractive and Craig always wins. One time the boss said he talked to a woman who had put Clyde first. He had grabbed Clyde arms squeezing his bones and muscles together: “Don’t hesitate!” he had repeated.

Craig G is not the only local of Clyde’s generation who educates Clyde about the lives that locals live. One day, Julio’s brother has come to meet Clyde and told him about the graphic violence he’d gotten caught up in at a club one night. Julio’s married sister was one of Clyde’s neighbors in Pierre Apartments. She has invited Clyde into her apartment and been really friendly.

Julio, one of the kids who works here, always comes at Clyde with a lot of aggression calling him a “Geiser” (or crack addict.) Also, he calls Clyde a “pus.” Julio makes it a habit to punch him while he is working on the grill.

One evening later on that Fall, Clyde will get fed up with Julio’s behavior and will agree to a fight after work. The boss will officiate and Clyde will wrestle Julio to the ground enough to demonstrate his physical dominance. Then, one fairly beaten, Julio will get up and give Clyde a unfettered knee in the balls.

Unable to speak for five minutes Clyde eventually will manage to call Julio a punk and a coward. The boss will look startled by this and clearly will not know what to do. Julio will just laugh and talk trash like Muhammad Ali.

Soon thereafter, Julio will show up at Clyde’s door step with his cousin and older brother. They will take him to the YMCA pool for a swim.

Clyde will go home after the swim and write a paper that his teacher will want to put up for a prize. Of course, Clyde will decline. He will only use the opportunity to try to make the teacher feel stupid. He hates teachers,

Clyde and Craig work the grill, the sandwich bar, and the pizza oven as the work starts to pick up. At noon the kid Angelo comes in and gives them each the neighborhood hand shake.

Angelo lives with his grandmother and is the oldest child to a woman who appears to be Developmentally Delayed. Clyde’s ex-girlfriend used to dote on him while she gave the neighborhood kids candy. She thought he was a cute and well-behaved boy. He had given his ex-girlfriend the biggest smiles and most sincere looks.

But currently, working with Angelo is a different story. Clyde sees another side of Angelo. Without having the benefit of a father figure, Angelo tends to get mad and bite back when told to do something. There are times he gets the job done and at times he goofs off.

Craig has just a little more patience with Angelo’s willful defiance yet rarely engages him. Clyde gets more frustrated. Thus, with Angelo, Clyde tries to step back and model Craig G’s tone.

Clyde used to work with this kid named Jose and had a much easier time. It’s true that Clyde already had a relationship with Jose having traveled with him to Pyne Point Park to help coach his baseball team. Clyde had known that Jose’s stepfather favored his younger brother and that Jose needed a little extra support.

When Jose had worked with Clyde, he had done everything right and there had been no disrespect. Since he quit, the neighborhood kids had all gossiped about him. Apparently, his step-father had sent him away to some mental health facility.

Today, Angelo directs himself to the walk in and stocks the shelves without comment. He also does the dishes in the back sink and takes the trash out. The lunch rush comes steadily for a few hours. When it thins Clyde and Craig take turns making deliveries. Then Craig leaves at two to return at four to close the store

At this point Angelo announces that he’s going to take his lunch. He walks to the front of the store and picks up a pornographic magazine and sits near Clyde. As Clyde slices meats, he flips through the pages sucking on his teeth and making a lot of delighted noises.

“Hey Angelo, you’re a little young to be checking out those magazines in front of customer,” says Clyde.

Angelo ignores Clyde with provocative expressions of delight.

The boss hears this and puts down his own pornographic magazine which is hidden inside a Korean Newspaper. He strides over from his perch at the cash register with his bullet proof vest on and looks at Angelo.

“No, that is bad,” he says, “You have to put that away right now!”

The Campus and City police come in frequently to fill their coffee or soda for free. All the neighbors point and whisper when the vice squad comes in. “They are the true bad guys,” a customer had once told Clyde. It will take Clyde decades of living to make sense of and understand these dynamics.

The only day Clyde didn’t see police abusing their power was the time the boss got held up at gun point and the owner showed up drunk with an arsenal of hardware. They were too afraid to come get free coffee that night.

Clyde can’t help but feel some judgement towards Angelo, the boss, and the police. What a fucked-up world they are all living in.

When Julio comes in for his shift and punches him and called him a Geiser, Clyde feels relief. Somehow, he stresses about Angelo’s morals and ability to survive the streets. He doesn’t know what to do.

The one-time Clyde will get his car window shattered, Angelo will come and tell him that Jose did it. Clyde will talk to Jose and easily discern that it was likely Angelo who broke the window. Whoever smelt it delt it. Sometime, Clyde fears, Angelo is going to get in trouble for pulling a stunt like that on the streets.

It will not occur to Clyde until many years later that he will have missed an opportunity to help Angelo out.

Clyde listens to the patter of the rain against the tarp above him. It’s an exceedingly gray day and he is sitting on the cement table and chair outside the mini mart. A mini-van rolls up along the narrow street.

When Clyde realizes it’s John Randy, he wonders how John ended up with a mini-van. The door slides open and Clyde recognizes a kid he used to know from grade school and a girl from his graduating class along with two other non-descript white twenty-year-old males.

Clyde’s hair is slicked back with gel. He is wearing a black Marlboro work-tee-shirt, his two- toned florescent green shorts, and his old-school white and black Converses. He doesn’t even think about the fact he smells like the deli.

The front seat is open and Clyde demurs a moment. Then, against his better judgement he opens the front door and climbs in.

His old grade school acquaintance is extremely friendly and catches up with Clyde in a graceful manner. Clyde has heard he is in construction, not school.

Clyde remembers sitting at the table in the grade school library with this guy and talking about war. “Better to kill them than have them kill you,” this guy had exclaimed.

Those were the days when Clyde had clout and confidence, back when he was formulating his pacifist philosophy.

Junior high had turned this kid into a metalhead and a part of the crowd that excluded Clyde. The kid’s favorite band had been Judas Priest.

Clyde tries to be friendly right back at him; however, he notices he is self-conscious. He does not feel grounded and in-the-zone the way he does when he is working with Craig G.

John Randy drives and the van is quickly over the bridge and on the interstate.

One of the nondescript males keeps talking about the dangers of Delaware cops. It seems very important to him that he is going to do something to break the law.

Yeah, yeah, thinks Clyde, Delaware cops are strict big whoop. This asshole needs to get over himself.

Before long John Randy pulls over on the interstate. John runs over to some bush in a wet green pasture and starts taking a leak. Clyde climbs over to the driver’s seat. Clyde learns they are driving the family van of a school associate. The family is on vacation and Clyde doubts they would approve of this expedition.

John Randy is still out urinating on the bush. Clyde feels he has unwittingly been had again. Now he is the designated driver of a stolen vehicle. The crew talks in the back and John is still urinating. They had all been fools to let John drive at all. No one else seems the least bit concerned about the danger that this posed! And the urination continues.

When John finally gets back into the van, Clyde focuses on his role as a designated driver. The crew is blazing weed and drinking in the back. Through the rearview mirror, Clyde spies the girl who graduated High School with him inhale.

Clyde still can’t help but get anxious when he thinks about the blaze of weed. He decided early on that he was not going to be pressured into doing any such thing, ever. Still, the fact that he has to stand out pumps up his anxiety.

He often thinks about how people have died smuggling her that weed she is inhaling! He knows how well these cohorts were treated in the insulated private school they attended. His father and mother were teachers at the school they attended. His father was a top administrator.

Clyde feels all the students at his school had it so easy. He feels this way especially since he has moved to Camden. Every time he sees his cohorts from that school all he sees is that they always want more.

Clyde doesn’t think about how this girl who inhaled had a mother who was a secretary at the school and how she was also (like Clyde) a scholarship kid. She may well have problems like he has! No, Clyde just thinks and thinks about how greedy it is to partake in what is essentially a slave business.

People like the kids will go to jail so the likes of he and his cohorts can be enthralled with no consequences.

As Clyde fumes, his cohorts coincidentally start to criticize his driving. Perhaps they can sense his judgments. Clyde remembers John Randy taking him to a house party back when he lived with him during his senior year. When Clyde started to fulfill his role as a designated driver, John Randy exclaimed that he was driving like an asshole. Clyde really didn’t know what this meant. Is this how all sober people get treated, or just him?

Now Clyde has to get off at an exit to fill the tank. The problem is that everyone has pitched negative energy his way. Some start directing him toward different exits to get off the interstate. Clyde can’t think. When he finally gets off there is no gas station to be found.

He gets on a road that heads the wrong direction and decides he’ll save time and make a k turn. The problem is that he is used to driving a stick. He instinctively reaches down to put the car into reverse and gropes at the air. Car headlights head towards him while he searches for the transmission lever to put the car in reverse. He jams on the gas and the van peals out backwards. Now everybody is laughing and criticizing his driving. Clyde is very distressed.

Drunken John, somehow realizes he has to calm Clyde. He steps up and directs him to a gas station.

When Clyde finally arrives at the stadium, the dark clouds are moving into dusk. The parking lot is full of tailgating hippies. Clyde is entertained with odd sights of funk. There are a ton of white kids his own age from sleep away colleges that he is not used to seeing.

He follows along while his eyes drink in the scene. There are no sport teams that he knows of in Delaware but the stadium is sizable. He is afraid he will be seen as just another damn hippie amongst the crowd without any awareness that he stands out like he is Where’s Waldo different.

Inside the stadium they find seats.

Looking out the stadium through the cemented exit walls, he can see hippies who must be jumping on trampolines. They are silhouetted against the dusky skyline. Clyde watches as every time they bounce up, they strike a different pose. There is water spray that is just barely visible surrounding them though he cannot see where it is coming from.

He can’t help thinking of the parents of these lost souls and wondering what they think of their kid’s lifestyles. This fills Clyde with a sense of sadness.

It will be eight years later when Clyde will learn that hippies use spray like that to get people on trips. LSD is something he should know more about. His grandfather was the head of the Harvard psychology department that hired Timothy Leary.

Many decades later Clyde will learn that his grandfather presided over the same department that conducted mind-control experiments on the likes of Ted Kaczynski (the Unabomber,) Whitey Bulger (South Bostin’s Irish Kingpin) Ken Keasy (musician in the Grateful Dead) and Robert Hunter, (Author of One Flew Over the Cuckoo’s Nest.) This clandestine program was entitled MKULTRA.

All his mother had told him that his grandfather had done some work for the CIA.

Clyde has learned that Phish formed at the University of Vermont. He can’t help but like the look of the lead singer and guitarist as he is clearly talented. However, as the night wears on the music gets stranger, more intoxicated and psychedelic. At one point John Randy leaves his seat and joins the crowd that is standing close to the stage. Clyde hears one of the others say that John is on an acid trip.

Toward the end of the show as Clyde is getting tired. He has found the long riffs self-indulgent and the psychedelic screech of a violin bow on a steel guitar just sound just plain stupid.

Clyde often looks out the exits as the hippies trampolining in the mist. They are now harder to see against the dark sky. They remain silhouetted by the exit lights. He finds himself looking at his watch frequently. He can’t wait to get going.

Back at the minivan, Clyde continues to think about how stupid everything is.

If he were a cop, he would just perch himself outside the stadium and pull over these badly behaving white kids and cart them of to jail. He starts to imagine the amount of DUIs and drug busts that could quash hippy glory.

All these white kids are allowed to come out and talk tough about evading Delaware cops and risk marks on their permanent record, but it’s all so fake.

Clyde reasons that the police are not allowed to target them. The promoters probably pay the cops off. Clyde thinks if it was found that the band was causing arrests to happen there would be less money to be made and it would be bad for business. He thinks of the neighborhood kids back in Camden and how the lure of the crack trade results in death and imprisonment. The whole scene just makes Clyde so angry.

As he drives out the parking lot John Randy is in the back getting a lot of love and support from the crew. Clyde is tense. He watches the stadium fade out of his side window as he follows signs back to the interstate.

As Clyde drives, he thinks of his ex-girlfriend who would agree with him about the stupidity of this summer evening. It is the only thing he really misses about her.

His mind flashes to the time she got mad at him and threw a milkshake against his windshield. It hit the windshield like the thud of all her attacks.

The attacks would start when she would get mad at him for leaving her Christmas morning to celebrate with his family. Months and months of the silence treatment would ensue. Clyde had found it very hard to be treated in that manner. Clyde remembered how he would often end up in tears after sex. She would be on top and he wouldn’t understand his own reaction. She would yell at him like he was her drunken father. It wasn’t until he needed to leave that shit got really bad.

Leaving her has been so hard. Everyone she knows hounds him about her resulting depression and sadness. It has been ongoing for over a year. The neighborhood was definitely on her side. Meanwhile, she stalked him and sat beneath his apartment window many nights.

Clyde listens to the crowd mingle midst the smell of alcohol and reefer. As the party starts to die down John Randy makes his way up to the passenger seat and keeps Clyde company.

Clyde thinks of the way John shamed him describing his father’s devastated look when Clyde was in the hospital. He remembered how John came at him for no reason and tackled him and held him down during the year they lived together. He remembered most recently how John had shamed him for leaving his ex-girlfriend.

“What’s on your mind John Randy?” says Clyde

“Not much Clyde Ryan!”

It’s been a long time since Clyde’s heard his real last name.

John looks out at the refinery lights and talks about them in a peaceful manner.

Clyde is reminded his favorite Bruce Springsteen music. A song from the Nebraska album starts to ring in his ear:

Mister state trooper, please don’t stop me, please don’t stop me, please don’t stop me . . .

New Jersey Turnpike, driving on a wet night, neath the refinery’s glow, where the deep dark river flows . . .

License registration, I ain’t got none. But I have a clear conscience about the things that I done.

Clyde remembers that John is tripping on acid. He reflects back what John is saying and comments. There is a long pause.

John has an artistic side and can be very creative. Plus, he knows what Clyde likes.

Then, somehow in unison they exclaim to each other: “Who is your Daddy!”

This loosens the tension in Clyde’s shoulders. He and John have known each other since they were three years old.

Once in kindergarten John had found a flat piece of balsam wood and wondered what it was. Clyde remembered a show on Sesame Street where they showed the making of bubble gum in the factory. John and he had used the Mr. Sketch Markers that smelled like mint. Together they had colored the balsam wood. Then they cut it into gun size pieces and chewed. They were both perfectly happy with the results until the teacher discovered their green tongues.

As Clyde listens to John peacefully interact with him, he is reminded of his older friend and fellow faculty brat, Chester. His first impression of sleep away college came from Chester.

When Clyde reflects about reasons that drugs just aren’t his jam, he thinks of Chester who will one day be his step-brother.

Clyde had suspected Chester might be gay. There had been some squeezes that had made Clyde uncomfortable. But Clyde had just ignored them and moved away. He really cared about Chester.

Then, there was the day Chester had come home from the dorms at Wesleyan College.

Clyde’s parents had just split. There was no one to talk to about his despair. Other friends hadn’t talked or seemed to care about it. Clyde had wished they would. He didn’t understand why no one cared about him. There was just so much despair.

So, Clyde welcomed Chester home and hoped to have a meaningful talk about his parents’ divorce.

They had been in the basement and got distracted from their ping pong game. Chester started telling him about college and interacted with Clyde in the same way John Randy is now communicating, using metaphors and making observations.

Chester had boasted that his college was one of the best pot smoking colleges there was. He’d reported that he’d done acid and that he had a crush on a guy who was in the jungle breaking trails with a machete. This was puzzling to Clyde.

Clyde had ignored the sense he was falling into a trap. Yet he continued to hide his distress and deny what was happening to the friendship. Finally, he learned that the jungle man Chester had a crush on was himself. At that point they had made their way up in his room and Chester tried to kiss his hand.

When Clyde had come to and he was hiding behind a sofa in the family room and Chester was in the kitchen talking to Clyde’s mother about gay marriage.

Now Clyde not only hadn’t had anyone he could talk to about the divorce, he didn’t have anyone to talk to about Chester. His Mom hadn’t proved useful.

In fact, his mom will silently judge him for years about being so sensitive about the incident. She will use this as evidence that Clyde is mentally ill. One time she had a girlfriend kiss her and she just said no and it wasn’t a big deal.

Clyde now thinks that Chester was likely tripping on acid. Somehow it helps explain why he was so freaked out as a teen.

Clyde was not proud of cutting off Chester. His resulting homophobic feelings, and the series of men who would later hit on him would be very painful for him to experience.

Clyde looked over at John Randy who was now sleeping and remembered an incident that happened a few years later with his mother.

Clyde had been noticing the way his mother was clearly acting very different with him when he came home from his summer work camp. She had been more permissive than she had ever been previously. When they went backpacking together, she had needed him and he had a sense of being idolized. Hypervigilance made him feel like it was a trap.

Then, the night he got his driver’s permit, his mom got really lit. Clyde didn’t think it was only wine she had been sipping. He had never seen her like this. She began begging him to go out and break the rules with her. She told him about all the men that were hitting on her but they weren’t as good as he. She begged and pleaded. She seemed flirtatious.

After that incident his mother seemed to cut him off. She was out partying most nights while he was up late working into the morning hours, completing school papers. The only contact she had with Clyde it had seemed was to yell at him for not eating. She didn’t show up on his prom night.  He was in the process of losing all trust he ever had in her.

That’s right, drugs may not be Clyde’s jam, but eating irresponsibly certainly was.

The following summer Clyde had landed in the hospital for the first time.

It will be many decades later but Clyde will remember being fondled in a bathtub by Chester’s sister when he was in third grade. Was it possible that this had started his hypervigilance and antagonistic feelings about sexual activity?

Not long after, Clyde will remember witnessing rape and incest among family friends. He had joined the family at a vacation cabin on the Rancocas River. He will only recapture fragments of memories. The graphic memories will feel dream-like and surreal. All he will know for sure is that he had run and been a complete coward. He is a runner not a fighter.

Once Clyde will realize he has a thing about blacking out these memories, it will bring up the question about other forgotten memories and his ongoing hypervigilance and inability to trust, forgive, or accept loved ones. Not trusting his poor mother will be a real problem whether or not it is justified.

Suddenly Clyde recognizes he is in Philadelphia nearing John Randy’s apartment. One of the non-descript male passengers is making a big deal that a cop is tailing them.

Jolted back into reality, Clyde is at a red light and accidentally jams his foot on the gas petal. The light is red and the minivan lurches forward through the light. He is so upset at himself.

“Wow, I love it! Fuck the cops,” said one of the nondescript passengers.

Clyde remembers how John Randy had invited himself to move in with Clyde when he first dropped out of his fancy college.

Clyde found he had mixed feelings about giving up his studio. When the bugs did not prove to scare John away, Clyde had relied on his therapist to help him tell John Randy, no.

Clyde didn’t want to wake up to the smell of reefer or get that reputation amongst his clean and sober neighbors.

So, John rented a place in West Philadelphia out by the colleges. It will take some years but eventually Clyde will realize that Johns father somehow owns the apartment complex.

The minivan finally arrives at John’s apartment. The crew disperses into their various vehicles. John stumbles inside and the lights go out. Then, Clyde goes home.

Luckily, for Clyde, it is a short walk to the Frankfort “L” line. Then it is just one transfer to the high speed-line.

Though Clyde has done this trip many times before, it is already past midnight which means that the stop by Camden’s Market-Street—the one close to his apartment—will be closed. He will have to get off at the downtown Camden exit. Clyde doesn’t care, he knows how to handle himself.

He finds himself thinking more about his choice to move to Camden. He remembers how his classmates had thrown him a party when he came back from the first of his hospital stays. He has to admit it was a nice thing to do, but John hadn’t really bought into the niceness of it. His heart towards his schoolmates had turned sour in the hospital. He no longer openly trusted anyone.

Kids from the streets had seemed to care more about him than his cohorts at private school. At least they saw and supported him while all the issues he had with his parents were stirred up. At school he was usually invisible.

Then, when the treatment failed and he got switched to an all-female unit, Clyde had continued to suffer stuffing his belly. His classmates just couldn’t understand the hell he’d been through.

Instead of accepting their good wishes and gift certificate graciously, he had been visibly embarrassed if not angry. He had thought about the fact classmates were the kids who had always teased him for being out of fashion and who tended to exclude him.

If not for the hospitalization, Clyde may have considered that he’d overcome these issues his junior year. He planned and organized the student body to get active in social services.

But being the identified and abused patient has a way of changing one’s perspective. Plus, John Randy had let him know that his partner had, behind his back, taken all the credit for all of his work. Many of his cohorts believed her.

Perhaps many classmates had observed his embarrassment and opposition. They would tend to take opportunities to cut into Clyde his senior year in high school when he was living with John Randy. After graduation he just wanted to get away from them as quick as he could.

When he had lost weight and had returned to the hospital for a second stay, he had invited this twenty-five-year-old photojournalist he had met at a school event to an event with his class.

“They all said you were bulimic not anorexic! And they were not very positive about you,” the photojournalist, soon to be his twenty-five-year-old girlfriend had said during their courting. Now at twenty-seven, she was the ex-girlfriend.

This had confirmed to Clyde that he had been right not to trust them.

Clyde’s mother had already let him know she was gossiping about him in the family sessions. She glorified the concerns and condolences she got from the popular kids in Clyde’s class regarding his bad behavior. Clyde couldn’t believe the therapist allowed his mother to taunt him in this manner. But the therapist had started punishing him by not letting him speak due to his non-compliant behavior.

Thus, his girlfriend’s words had confirmed that the gossip was slander and that it was controlled via his parents talking to their friends, his teachers. Clyde felt the whole school was unified against him and it only fed his self-destructive streak.

He had never started throwing up until they forced him to eat in the hospital.

In reality, Clyde’s accurate intuition often made things worse for him as it prevented him from faking his way into better relationships with others. Indeed, Clyde’s accurate intuition will get him in all sorts of trouble later in life until he learns this lesson.

Indeed, in the train it is hard for Clyde not to feel tragically flawed.

As he comes up the escalator out of the speed-line stop, he exits the tinted glass doors to witness a knife fight between two men surrounded by a sprawling crowd. One of the men stands upright with his fisticuffs up while the other positions himself horizontally swinging his knife widely. Clyde thinks about how everyone is out testing their nerves and wonders what the fight is about as he motors through the crowd.

By the time he is approaching Federal Street a black man takes a look at him and gives him support for his look perhaps or for just being out at this hour of the night. This helps Clyde feel safe. He is grateful to all the angels he’s met in this city who support him in this way. They far outweigh the stereotypes.

When Clyde hits Cooper Street, his pace quickens. He cannot wait to get back to his apartment. He takes the elevator up to the sixth floor and as soon as he enters his piping hot apartment the poor cat showers him with love.

But Clyde doesn’t waste much time with the cat. He skips over the carrots and the fruit and immediately attacks the graham crackers. Then he hits the ice cream. He isn’t even trying to restrain himself. He goes after some Pathmark muffins and makes sure to hit some of his ice, cold Crystal light drink. He eats the rest of his yogurt covered pretzels and is back at the ice cream.

After a while he goes through the closet, into the bathroom and braces himself on the sink (the throat.) He let’s go of all the disgust he feels from the night out with his so-called friends. The food blurts out of his mouth in clumps. He uses his hands to detach the clumps from the sink and wash them down. Sometimes he gets impatient and just jams the clumps into the throat. When he is empty, he returns to eating.

Clyde focuses his mind on Gwendolyn and Ray and the few people he can trust at the deli. Still, he cannot stop until he has made a dent into his hundred dollar a week food supply. In the hospital he had gone to AA meetings. He doesn’t need to turn to drugs to help him cope with the meanness in this world. He already has his jam. He pukes until he is exhausted. Then, he goes to sleep.

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Why Clinicians Need to Address Institutional Trauma:

According our country’s cultural delusions, social institutions take care of people and deliver social justice based on a persons’ merits. Institutions for education, law, health, religion, athletic achievement, arts, recreation, work, transportation, housing, and social entitlements are often thought to be entities that people can trust to learn from and get the support they need to thrive in society.

Yet, there violence in the streets. Many come out of jail worse than they were when they went in. Help proffered in our involuntary psychiatric units leads to a revolving door and distain for therapy.  Board and care homes and halfway houses may subject individuals to a sense of poverty. Many of our institutions become the source of pain and trauma. Some institutions work for some people. Some people get targeted, punished and hurt and become marginalized.

Intersecting generalizations about race, socioeconomic status, gender, sexual orientation, gender identity, citizenship, mental and physical health interfere with a person’s capability to self- actualize. Some people are raised to fight and fend for themselves by any means necessary and there are institutions built for them; while others are insulated from these challenges and have wealth and sometimes luxuries to lean on; and there are institutions built for them.

Cliques and societies are formed in every institution that push out people who don’t belong. Some peoples’ skills are celebrated while others are ignored and undermined. Sometimes based on a stigma, a slander or a gossip, skills or abilities get lost.

While often abuse is thought to start in the family system, much of our lives are spent outside the family in institutions that are supposed to guide us in the right direction. How, then, can some of us become mired in mental anguish? Institutional abuse is important to consider when people are suffering.

The Importance of Doing an Institutional Analysis:  

Assessing a persons’ attitude towards the institution is important towards knowing if that institution has functioned to abuse the person. Institutions can do harm in many different kinds of ways. It doesn’t only depend on what the institution is meant to do.

Consider people who thrive in an institution. If they have dealt with an institution that is positive about them like earning a spot on a travel sports team, has it led to better performance and has the selection turned out to be a good outlet for their skills and esteem?

There is a lot that can go wrong on a sports team. When a person doesn’t thrive and optimize their skill it is important to know what happened. Perhaps they went elsewhere and found another outlet or discipline to perform. This happens when we assess people’s passions and interests.

Many clinicians tend to do an institutional analysis in this manner without thinking about it. When dealing with institutional trauma, it becomes important to help a person utilize contexts and times they have thrived in institutions in order to look at the times when they haven’t.

When there is a positive experience, it is important to extract resources from those institutions. If they have a negative outlook on an institution, it is important to learn about the institutions that they did feel good about. If they did have some good experiences in which they thrived, it is important to understand what went wrong.

Often, one doesn’t get this kind of information on the first psychosocial experience. A clinician needs to remember institutional issues and return to them and excavate them later in session.

It is also important to consider resources that often aren’t addressed. Have they had success with a peer group? Have they any attachment to counterculture? In some contexts, it is important to consider institutions that are not given legitimacy like jobs working for black market industries. It is important not to judge the institution, but rather to explore it for resources.

Mental Health Institutions:

Not always do institutions with negative stigmas do people a disservice. Even when the purpose of the institution appears to be to ruin the person’s life, there are often opportunities for good learning experiences that help a person avoid complete defeat.

Thus, if they have come to contact with an institution that is thought to be negative such as a county jail or a county mental health facility, the question becomes what have they learned about themselves from the experience? In the case of mental health institutions labeling a person with a diagnosis with a poor prognosis: do they agree with the negative prediction? What happens to their social performance when they leave?

In my experience with public mental health institutions, compliance may result in a worse outcome. In twenty-five years of working in them, I have tended to see that many programs are built for social control and to maximize financial gains.

Often the way things are set up is so top down that the individual’s needs get lost in the process. Cookie cutter concepts of evidence-based practice often fail to promoting health and healing and personal growth. Some people just get worse and worse over time so that labels like schizophrenia get to be thought of as illnesses of progressive decline.

It is clearly arguable that understanding any person involves understanding how they fit in to the institutions in which they associate. It is not enough to simply learn about the list of institutions that have impacted them. It is important to learn about how they dealt with socialization in the facility in order to learn what they learned from their experience.

Thus, a clinician needs to be patient and not make too many generalizations. After all the secret stories and heaps of bullshit that might need to be excavated. A great question to ask is about people who worked in those contexts that didn’t fit the mold. Part of my reason for writing this is to encourage more people to work in these contexts who learn to counter the negative missions of many institutions.

Assessing the Impact of Abuse Within the Institution:

Often, institutional abuse is covered up and needs to be drawn out to even get seen. The victim may not even have the power to have anyone believe a word they say and that is frustrating!

To help a person heal from institutional trauma, a clinician must learn to see the person they support in a different manner than the institution that damages them sees them. That means acknowledging than an injustice is happening becomes a first step. Too many clinicians working in an institution aren’t inclined to do that. Many workers accept the status quo and impose increased trauma on an individual especially when the person is negative about the institution as they are going through it.

Acknowledging the harm is the first step. Often this is simply a listening skill that needs to develop and a sense of justice is necessary. Sometimes a clinician can suspect this is going on and ask questions that can draw out stories and abuse.

Then, a clinician can develop an alternative narrative for how things might be if the institution was being fair to them. It’s true a clinician can’t change the institution, but they can articulate and advocate for what is needed for a particular client without being able to deliver it. This is essential to building an alliance and mitigating the damage being done. It is a direct route to healing.

It becomes essential to look at what is happening through the client’s eyes.

Understanding Your Institution’s True Mission:

Each institution has a mission and people it is trying to serve. For example, if the county mental hospital is there to prevent homeless people from committing suicide it can be important to acknowledge that that is what the institution is trying to do. This might help the person who has been damaged by the institution realize why they did not fit in and get the help that they needed.

Puzzling through a county’s mentality in treating people also involves considering the bottom line which is the way the institution makes money and survives. This involves understanding the counties finances and the need of the contracting agencies to make money.

In a federal prob the county where I work has been deemed to be criminal in its services. A lot of money goes to emergency hospitalization services and not a lot is set up for treatment outside the hospital.

Abuse might involve more than just suspension of a persons’ bill of rights. It might be an institution is built to control violence and impose involuntary medication and this might have nothing to do with a person’s needs.

It might involve exposure to substandard facility hygiene and this might or might not be what the person is used to. Some might see an unhygienic unit as an insult while others may recognize it as like many other unkept situations they are exposed to.

A therapist is keen to understand the mission of their institution. Believe me it is not in the institutions mission statement! It is more likely to be seen in the metamessages that the institution puts out. It requires real-life interpretation and perhaps some Marxist financial analysis.

What was wounding about the true mission of the institution when it didn’t suit the person you are seeing in the therapy room?

Examples of Differing Institutional Missions:

In my life I have had a lot of conflict with the missions of the institutions that most powerfully affected me. I share them now to demonstrate the kind of race and class bias inherent in institutions. Indeed, if I were your patient, understanding how the mission of three of the institutions I have been subjected to is important to understanding my trauma.

When I was admitted to a state hospital during a break, it seemed like the institution was there to prepare me for living in permanent poverty. The presumption was that I would not be able to work and that I would therefore have to adjust to board and care poverty. It was built into the institution as a mechanism to fill the local businesses, according to my observation.

Enduring that mission, being treated like a piece of cattle in the field, was very hurtful to me when I transitioned back into professional work. It is important to understand the impact that being treated in such a manner has on a person.

In contrast when I attended a private prep school, ten years prior, I was taught that my classmates and I could be anything we wanted to be if we just did what they said and got transferred to an elite university. What mattered was the prestige of the university.

When I decided that I didn’t trust that institution and figured that prestige was some bullshit, four years later I graduated from a local commuter campus in the inner city. The message I got as a freshman, that most people I went to school with weren’t going to graduate, demonstrates that the mission of that particular institution was very different than the mission than my private prep school.

The help I got from the career center suggested I should be a cop. I don’t think many of my prep school graduates became cops. Believe me, it’s not the only time I was invited to join a gang that may exacerbate social violence. I received several offer in the state mental hospital.

In my case, I could see the contrast in the different institutional missions and I always knew that I didn’t fit the mold. I didn’t trust the mission of the prestige prep college. That is something you would definitely want to explore.

Luckily when I was discharged to the streets from the State hospital, I had three thousand dollars to start my life over and prove that I could work in spite of my “break.” There is a lot to explore and many stories to be told. I am in favor of letting the stories be told while assessing the re-traumatization factor. Too many clinicians are afraid to know or counter the mission of their appointed institution. We need more therapists who stand against the mold in the institutions. They do matter and can help.

The Importance of Having Faith and Extracting Resources:

It is true work on institutional trauma takes time and is best done when the clinician has a strong sense of the persons resources. There are times when the person needs to rant and rail against the way they are or have been treated. A clinician who does not believe the resources that might exist or who starts to extoll the virtues of the institution really can set the person into a traumatic response.

Thus, I think clinicians need to have faith in a person’s inner resources. I can be hard to teach this especially when the clinician is not native to the persons culture or contexts. It takes a long time to learn these multicultural skills. Setting up systems in which students and young workers are responsible for knowing things they just don’t get is not a good way to train or heal institutional trauma.

Keeping pay at entry-level salaries, hiring people who don’t have a background outside a degree, and having young managers who are eager to advance and lack cultural understanding is not a good way for organizations to address institutional trauma.

I believe clinicians who have humanistic views of various kinds of people who don’t judge people about external behaviors have a better chance of extracting a person’s resources and helping them love themselves again. Conversely being fearful and condemning of a person who has behaved in problematic manners is a good way to have the person clam up about their resources. When a clinician maintains that kind of stance, it can become a self-fulfilling prophesy that exacerbates institutional trauma

The post Why Clinicians Need to Address Institutional Trauma: appeared first on Redefining "Psychosis".

Media’s Misrepresentation of Criminality and Psychosis: How it Affects Real Life

Guest post written by Samantha Jane

From Alfred Hitchcock’s Psycho to M.Night Shymalan’s Split, the media has long been guilty of using psychosis as a scapegoat for fantastical criminality.

Even among newsrooms and journalists, crimes attached to any iota of mental illness are sensationalized with splashy headlines. This macabre fascination has only worsened the existing stigma towards mental health. With over 70% of the American public getting their mental health information from TVs, newspapers, and magazines, it’s not surprising that these inaccurate depictions have had negative effects:

Cases of criminal malingering have increased

A prevalent effect of misrepresented criminality within psychosis is the proliferation of malingering. Described as the act of feigning insanity to evade a heavier punishment, malingering occurs in about 17.5% of convicted criminals.

One infamous case of malingering involves one-half of The Hillside Stranglers Kenneth Bianchi. After terrorizing most of California in the 70s, Bianchi pretended to have an alternate personality (Steve) when he was captured. And he argued that Steve was the actual perpetrator. Bianchi was ultimately found guilty after his ruse was debunked. But at this point, his act had lengthened proceedings and cost the state more money. Since then, both criminal defense lawyers and convicted criminals alike have tried malingering, with many simply mirroring the signs of psychosis they see on film or TV.

Law enforcement has had to pivot their approach

As a direct consequence of the previous points, law enforcement officials have had to further their own understanding with regards to mental health. To prevent malingering and to justly identify defendants who were—or are—suffering from psychosis, many local and federal officers implement forensic psychology into their investigations. Officers who have completed either in-person or online forensic psychology degrees have been trained in abnormal psychology, criminal behavior, and social sciences. This enables them to make educated preliminary assessments of persons of interest.

Alongside this, a growing number of cities are implementing crisis intervention team training. These programs teach officers de-escalation techniques and the appropriate way to divert individuals to mental health services, when available. While these efforts have shown significant dips in unwarranted arrests or violent altercations, many states have yet to mandate these initiatives.

Vulnerable communities are further alienated from society

One of the most dangerous consequences of misrepresentation and sensationalization is the picture that it paints of those with mental illnesses. Under the guise of “informing” the public about red flags that indicate criminality, people who consume this media are influenced to fear those with mental health conditions. For instance, data suggests that 40% of all police calls are mental health-related events. This is despite the fact that only 5% of all violent crimes are committed by individuals with pre-existing mental health disorders. A study even shows that those with mental illnesses are more likely to be a victim of a violent crime, rather than the perpetrator. But even in more “white collar” circles, people are conditioned to perceive those with mental illness as untrustworthy or subversive.

Such was the case with Tim Dreby when he shared his own workplace experiences as someone with diagnosed schizophrenia. Despite the fact that Tim worked in the field of mental health, his diagnosis and survival story was used almost as blackmail. Unfortunately, a similar story is echoed across the nation as surveys show those with mental illness are up to seven times more likely to be unemployed.

Will Media Be Changing Anytime Soon?

True crime shows and horror movies are some of the most well-received media today. So, unfortunately psychosis will probably continue to get associated with criminality. Of course, this isn’t to say that some changes aren’t on the way. Organizations like the United States’ National Mental Health Association (NMHA) and Australia’s Mindframe program have begun to suggest guidelines that more fairly and safely depict mental illness. Whether these guidelines are to be widely used and accepted, though, remains to be seen. For now, criminality and psychosis are still part of an industry that seems to have little care for the widespread consequences they encourage in the name of “entertainment.”

Article written for timdreby.com

By Samantha Jane

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