Self-Management of Psychosis and Schizophrenia

Dana*

Reprinted from "Self-Management" issue of Visions Journal, 2003, 1 (18), pp. 18-19

To some it might sound like an oxymoron, but many believe it possible that people with schizophrenia can manage this illness in a way that will enable them to lead fulfilling lives. I present three accounts in favour of this approach. One is by Canadian Robert Chapman, who recovered from this illness and now speaks to others about his journey to recovery. Another presents excerpts from UK’s Rethink Project. And the last one is my personal look at this issue as someone who has been hospitalized and recovered from psychosis.

Robert Chapman’s Approach

Robert’s Chapman account of his fight with schizophrenia is one of determination to conquer delusional beliefs by replacing them by others that are based on reality. At first, Chapman became angry at the illness, a turning point on a slow path to recovery. He says that “there ought not be a race in trying to recover.”1 Although it is an illness that is usually branded on people as a terminal one, he did not want to accept that fate, and by applying ‘method to his madness,’ developed ways of controlling it. What started Chapman down this path was when someone told him that his ideas were part of an internal process related to his disease, rather than something external. This allowed him to develop his method for testing out his often-delusional ideas against reality.

Chapman’s three-step strategy worked as follows:

“The first step was to recognize the delusional scenarios. Evidence for delusional ideas were found to contain doubt. Second, I developed counter-arguments and explored alternative interpretations [for my delusional interpretation]. The third step was to replace the delusion with reality, truth and rationality.”

He developed the method over the course of several years. After that, he went public with his findings, to share this journey with others on TV, in newspapers, conferences and in books he has written. Unfortunately at present, his books are hard to obtain in libraries or bookstores since they are out of print. However, his website, www.nas.net/~chapmanr, describes the approach in more detail.

Rethink: Self-Management Project for Schizophrenia

When considering self-management, we shouldn’t just focus on eliminating the negative impacts that the illness has on our lives. The organization known as Rethink, based in the UK, conducted a study that asked people with schizophrenia their views on self-management.2 And as the study showed, a focus on the positives of the illness experience is also an important aspect of self-management. For instance, one person interviewed in the study noted the positives of “having a feeling for sounds of words and seeing puns in what people say — loving music and feeling at one with nature and the universe — being strongly affected by beauty in a positive way”; another felt that he was “a much better person for having suffered… and …many facets of my personality have developed as a result.”

The Self-Management Project finds that self-management is an individual journey, but one with common themes such as:

  • acceptance of experiences

  • struggling against societal stigma

  • journeying through different understandings of illness-related experiences, including the psychiatric, social and spiritual

  • over a period of time, developing hard-won coping strategies

  • having to choose between fitting into ‘normal’ society and redefining what ‘normal’ is and giving value to difference

The self-management strategies in this approach and in the one discussed above involve more than medication. They also involve communication with the person about the illness experience, as well as developing ways of evaluating and countering unhelpful ideas, such as delusions, paranoia or negative ideas about oneself.

My Personal Experience

From my personal experience of psychosis, I found that the turning point in my hospitalization came at a time when I was thinking that I could not trust anybody, that everybody wanted me dead, and that there was no other escape other than suicide. Gradually, I started remembering my childhood and the times when I was loved and when I trusted people. I then made a decision to trust someone that I knew and felt good about.

And that’s how I started climbing up the ladder from the pit of delusions and hallucinations. Another turning point was when I was finally provided information about schizophrenia: the first diagnosis my doctors gave me. I asked them repeatedly for it, but for some reason they were reluctant to give it to me until almost the end, when they deemed I was ‘ready.’ Once I held this information in my hands and was able to read academic text — just like I used to for my classes at university — I realized that all the delusions of grandeur, paranoias and hallucinations I experienced had also been shared by many others before me. I also realized that I was not as special as I thought I was, in the grand scheme of things, and that I would be able to lead the normal life I wished.

After that, I had to relearn how to look at people and to walk the streets in the same way as other people do. It was hard because I was still fighting my delusions and was ashamed of what had happened to me. But slowly, within weeks, my rational thinking and determination brought me out of my previous frame of mind. My sense of humour helped too, in tackling the embarrassment of returning to places where my psychosis happened. For that quality, and for all of the strengths that enabled my recovery, I am very grateful to my upbringing, and to my wonderful family, friends and therapists.

Before I came back to SFU, where I was studying at the time, I flew back home to recuperate for the summer, and got excellent care at the Centre for the Treatment of Psychosis, where I received help from a psychiatrist, psychologist and cognitive therapist.

I think all of these things have been an important part of my recovery and my ability to self-manage, and I would recommend them to anyone.

 
About the author

Dana is a Master’s Student in Political Science at Simon Fraser University and Branch/Public Communications Support at CMHA BC Division

*pseudonym

Footnotes:
  1. Chapman, R.K. (1997). “Eliminating paranoid delusions and telepathy-like ideas in schizophrenia: A personal account.” In C.T. Mowbray, et al. (Eds.), Consumers as providers in psychiatric rehabilitation. (pp. 201-208). Columbia: International Association of Psychosocial Rehabilitation Services.
  2. Martyn, D. The experiences and views of self-management of people with a schizophrenia diagnosis. London: Self Management Project. www.rethink.org/recovery/self-management

 

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