How to Support Healing from Psychosis Versus Imposing Social Control

When a person has a break from reality, others often feel a sense of urgency. Most people think that if this does not get treated with antipsychotic medication immediately, grave and progressive brain damage will ensue. Friends and loved ones may fear that this is the beginning of degenerative process that will leave the person shuffling between institutions and poverty for the rest of their life.

This article is written for the loving supporter or social worker. It invites you to learn about the world of your loved one. My hope is that it will help you gain strategies for how to handle the relationship with someone experiencing psychosis.

The State’s Social Control Model
When you think about the public mental health system, images of crowded psychiatric emergency rooms, violent police restraints, rapid tranquilization needle sticks, jail time, or substandard warehousing barracks may come to mind.

These are all realities of the system. They are mechanisms of the state. These realities either neglect the person in the break or set them up to be forced back into consensus reality. It can become a punitive and damaging process.

Ultimately, I view the goal of the state as enforcing social control, not healing and recovery. It can become about saving money or making the afflicted impotent. It can become about endless submission, silence, and the perpetuation of lies.

There are times when the social control model does help a person improve their behavior. Improving one’s behavior can help a person minimize their risk of escalations of trauma via social punishment. It can be better than nothing. Sometimes, people can learn lessons from abuse, improve their circumstances, and even heal.

Efficacy of the State’s Social Control Model
Still, in America, state social control that guides behavioral change has a low efficacy in terms of promoting recovery. It’s more a part of the problem than the solution. Even of the people who receive early intervention treatment for psychosis, only 42% have a response classified as “good.” And studies in developing countries show higher recovery rates than developed countries! Could it be that state social control is still part of the picture?

Social myths and stereotypes leave many people thinking that degenerative decline is to be expected if schizophrenia is left untreated—when actually it can be the result of treatment. When such social myths are maintained, it can seem like social control is the only option to prevent a horrible outcome.

Still, as I suggested above, stints of incarceration can result in an increase in compliance with consensus reality. However, they also reinforce the idea that it is unsafe to talk about what is happening. In many cases, the follow-up homelessness or warehousing can be so hard that incarceration starts to look better. Throughout all such “treatment,” exhibitions of psychosis are systematically shut down rather than explored. Many go through this process and give up hope of ever working through their experiences with other people.

In this culture, when incarceration and trauma happen, all is not lost. As someone who went through a three-month incarceration that left me outraged, I believe we can learn healing alternatives instead of nurse-ratcheting up social control. Ultimately the fear of returning to dilapidated and neglectful situations did help me conform. I eventually found that with medication I could get better jobs and more quickly restore my social standing. However, it was a two-year process, and I feel like I barely got through. And the night terrors were bad!

And so, I believe that “healing” is not the most likely result of forcible social control.

Few Approach Psychosis in a Curious Manner

To promote healing instead of social control, I believe it is important to understand, normalize, and navigate the break. This doesn’t happen often enough in the system because most people are too afraid to be curious about psychosis.

Society doesn’t understand, and so neither do our psychologists and social workers! Mental health professionals are forced to do the work with little guidance. I was once one of them. Many are untrained interns/workers, and their managers may not be curious about psychosis.

Who is trained to be curious? None of my supervisors ever were. Many I work with question my tactics. There are few organized trainings for being curious about psychosis. Even if professionals are trained to work with psychosis, they may not be able to listen in a validating matter. Invalidating body language can trigger their loved one and they can conclude it is not worth it.

It is very hard to offer treatment when a person is incarcerated against their will and feels betrayed by the people who put them there. Curiosity about psychosis is imperative to initiating voluntary treatment. People who learn alternative ways and grow like flowers through the concrete cracks are so often marginalized.

Meanwhile, the basic myths are maintained. Most are trained not to reinforce the delusions. Others fear they will catch the disease if they listen. Still others fear retraumatizing the respondent and making them angry. Then they do because their fear is apparent.

There are ways around that—by validating the experience of psychosis, so keep reading.

Why Do We Choose Social Control over Healing?
There are several reasons that “treatment” via social control is so vastly promoted in the United States.

There is a very poor, medicalized understanding of what psychosis is. Unproven theories about the biomedical basis of psychosis—like the chemical imbalance myth, studies that find a tiny, clinically insignificant connection with genetics, and dubious, poorly conducted twin studies from 50 years ago—are all represented in the media as if they somehow explain psychosis as a medical condition.

If someone starts talking openly about hearing voices or referencing beliefs about being targeted or enlightened, the average person will flee or mock them. This translates into ridicule, social rejection, and pain—and couple that with the state’s aggressive treatments.

Too many people in the state and the public invalidate the trauma that ensues when social control measures occur. So many people feel it is justified. The state’s goal is simple: spend as little money on the victim as possible, tranquilize or imprison them, get them to fill unskilled labor markets, and don’t let them speak out against our cultural delusions. At least, that’s what I must conclude after a three-month hospitalization in a state hospital.

It can feel like there is not much left for loved ones and good social workers to do besides support the effort to socially control the person they love and wait and see if they will recover.

Some Basic Alternatives to Social Control
In order to promote healing from psychosis, it becomes very important to become uniquely adept at listening, validating, and contributing without getting confused, combative, or dissociated. Asking the right kinds of questions—being curious about any conspiracies the person expresses, rather than trying to argue against them—helps the person realize they are not alone. Trust building is very important.

It’s also important to assist your loved one in adhering to the requirements of work or making it possible for them to continue to socially network and have a social life. As L.A. psychiatrist Mark Ragins suggested in a CASRA keynote speech, work, or building relationships (to which I’d include studying spiritual traditions) are ways to teach us social skills, not incarceration.

Indeed, research in the United States behind Dartmouth’s IPS (Individualized Placement Services) model of vocational rehab suggests that a self-directed effort to conform to work with support is a real way to achieve behavioral benchmarks.

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In the IPS model, a job is provided until the subject fails, and then another job is found and maintained until it is lost. Keeping the person moving through the job situation and adhering to social dictates until they can master the needed behaviors to keep a job has been shown by research to be the way to go. It’s in the research! Everyone loves research.

Perhaps we can add this mentality to social and spiritual connectivity and enhance outcomes even further.

The majority of persons with psychosis want to work, have friends, and believe in god. They want to avoid a life of poverty, imprisonment, and isolation. Work is a good motivator, and a good way for many to learn to comply with rules. But it requires emotional support which can be hard for people with psychosis to find.