‘Psychosis’: bending reality to see round corners – Paul Fletcher


“Psychosis” is a term little understood, yet much misunderstood, much overused and much misused.

And it scares the living crap out of our society
but it doesn’t have to.

It’s a description – of an experience. One that’s more common than we pretend, more ordinary, and can be more useful.

We like to categorise things – especially each other- so we can pretend we know, pretend we’re in control. We like orthodoxies so that we don’t have to think and learn about difficult stuff.

Paul Fletcher shares some ideas and a few things he’s learning not so much from his own training as scientist but working with artists.

“Very much still a work in progress…
I hope it leaves you with the impression – which I intend to create – which is talented artists can say more in two minutes about this than I could probably say in an entire series of lectures.”

Paul Fletcher @ TEDx:

Treanscript:

“I am going to talk about psychosis.

This is an experience or a phenomenon that’s associated with a number of psychiatric, neurological, and physical illnesses.

But it’s something more than that, and it’s something that I want to persuade you is actually highly related to the way in which we process the world day-to-day trying to make sense of its complexities.

Psychosis is a much misunderstood, much misused, much criticized term.

It’s actually a description, a broad description, not a diagnosis.

And it refers to a loss of contact with reality, whatever reality may be.

The textbooks say that there are two key characteristics.

The first is hallucinations.

People may hear, see, touch, taste, feel things that aren’t apparently there.

The other phenomenon is the delusion, a seemingly irrational belief that arises without good evidence. And it’s held in a way that seems to be impervious to evidence that contradicts it. So that’s the dry textbook definition.My first experience with psychosis really came when I was a young medical student on my first psychiatry attachment in an inpatient ward in the Hackney Hospital, North East London.

And I spent a long time talking to a young man, who described to me in great detail the experience that he’d had of being sent messages from television, film, and radio, and newspapers.Messages in verbal, and visual, and even telepathic forms that were highly critical of him, very unpleasant, very threatening.

They even instructed him to harm himself with a knife.

I was deeply disconcerted, but also baffled by this, because he was a young man, who was articulate, intelligent, insightful, and yet, though we seem to inhabit the same world, the reality that he had was very, very different to my own.

And there’s no easy way of applying a simple loss of functional derangement or dysfunction model to understanding that.

Now, I’d like to argue that in order to begin to understand this, to get a glimmer of understanding, we need to take a step back and look at the way that the normal, healthy person in the world processes that world in order to try and make some sense out of its complexities, its ambiguities, and its uncertainties.

And I think through looking at that, we get a glimmer of the possibility that actually, many of us are in a pretty much psychotic state all the time. Primarily, the brain needs to be able to predict the world, to be successful, and to survive.

And in order to do that, it needs to build an internal model of that world outside.

And this is where the difficulty starts, because we don’t have direct contact with that world outside.

We have the illusion of direct contact.We have the illusion of reality.

This was put very nicely by Vernon Mountcastle, who was a neuroscientist, and he said in 1976,”Each of us lives within the universe or the prison of their own brain.

Projecting from it, are millions of fragile sensory nerve fibers, arranged in groups uniquely adapted to sample the energetic states of the world: heat, light, force, chemical composition. That’s all we can know of it directly. Everything else is logical inference.”

Now, this is a profound statement, because it’s telling us that we are actually bringing something to the act of perceiving reality. And it’s worth considering the nature of that inference.

Hermann Von Helmholtz, a 19th century scientist, thought a lot about perception, perceiving and experiencing the world as an inferential, logical process. And in fact, he said that it’s an act of imagination.

He said, “Objects are always imagined as being present in the field of vision as would have to be there in order to create the same impression of the nervous mechanism.”

What he was saying here was that we have impressions, experiences on our nervous system just as Mountcastle suggested. And we then have to imagine what could have caused those.

We back project to the cause of the sensations that we do have.

This is a form of inference, and it’s a form of inference that this chap here, Charles Peirce, an early 20th century philosopher, referred to as abductive inference or abduction.

Abductive inference really refers to reasoning backwards from evidence to the causes of those evidence.
So we have the evidence in our senses, we need to reason backwards.
And Peirce pointed out that actually this is one of the shakiest, most fragile, most tenuous forms of logical inference that you could have.

He referred to it as guessing.

And the reason is guessing is that for any given sensory experience that we have, there is a myriad, multiple, infinite number of possible causes that could have given rise to that.

And we are stuck with having to make a decision about what could have been that cause.
As Peirce put it, he said,

“The whole fabric of our knowledge is a matted felt of pure hypothesis.”

But we seem to get by.
We do manage.

And the reason that we manage is actually captured in a theorem that was developed by this 18th Century Presbyterian minister Thomas Bayes.

Many of you’ll have heard of Bayes’ theorem. You certainly come across it more and more in neuroscience nowadays. And Bayes pointed out, and in fact, Bayes, although he didn’t use the term, was talking about this form of abductive inference, about working out the causes based on the evidence.

And he suggested that the optimal way to do this is to take the evidence but also to take what you already know, what your prior experience and expectation is, and fit those together, and resolve the ambiguity like that.

So imagine you’re walking down a country lane – let’s say, in Devon, and you hear the clip-clop of hoof-taps up around the band. You confidently expect that what will come around the corner next is a horse.
But actually the evidence you have doesn’t tell you that necessarily.

I mean who can tell the hoof-taps of a horse from a zebra, or a camel, or

somebody banging a couple of coconut shells together?
(Laughter)

The evidence itself is ambiguous.

But of course, it’s your prior knowledge that what’s most likely to be around the corner in Devon is a horse not a zebra.

And that’s essentially the insight provided by Bayes’ theorem and the notion of the inference that we apply to the world.

There’s good evidence that this sort of inference also occurs at lower unconscious perceptual levels, and we’re doing it all the time.

Looking at this image here, to many of you who haven’t seen what I’ve seen, a meaningless collection of black and white blobs.

To me it’s not, to me it’s a very, very meaningful picture.

I can see a lot in it. I can see there’s a woman.

I can see that she’s young. I can see she’s wearing a hat.

I can see that she’s happy. And I can see that she’s kissing a horse.

And the reason I can see all that is not necessarily because I am hallucinating – although there’s an element of that actually, I think – but it’s because I’ve seen this image.

And this image was the original image from which the first one was created.

Now, having given you that prior information, that prior expectation, it becomes more possible that some of you may now be able to look at the image and see the woman kissing the horse.

This also works in the auditory domain.

If you listen to this  (Ambiguous sound) to many of you that will sound like a sort of meaningless bird-songy type of sound.

To me actually, it’s highly meaningful. The reason it’s meaningful to me is I have prior expectations and prior knowledge.

My prior knowledge comes from having heard this, (voice over)
“The camel was kept in a cage at the zoo.”

So now you have that prior experience and knowledge. Will you be able to apply it to the original sound?
(Ambiguous sound)
(Laughter)

It’s very, very striking, just how automatic and easy it is to now make sense of what was previously noise merely because of what you brought to the table.

So that’s great.

We’ve got a means of dealing with the world, which allows for the ambiguity of our incoming messages, allows us to assess what the cause is likely to be, by using this inferential process based on prior knowledge.

But that should give us pause, because it’s telling this: perception is an active process.
It’s not a passive, a receiving of a veridical world out there.

And if the process is active enough to allow us to suppress the noise, recognize the signal, remove the ambiguity, is it also active enough to create perceptions?

We are very prone to creating our own perceptions.

So here we see a famous triangle illusion, where most of us will have a very strong sense that there’s a white triangle super-imposed upon these black shapes.

The reason we see that probably it’s because the way the shapes are arranged below it seems to strongly imply that there is a white triangle, and therefore, we create it.

There is actually nothing objectively there.

There is no border here. There is no perimeter.

We’re seeing something that’s objectively not there.

And it’s only 10 minutes ago that I defined that as a hallucination.

So this is a hallucination in action.

And as Von Helmholtz described it, perception itself is controlled hallucination.

So we have this situation where we have a balance between what’s coming in and what we already know.

Under some circumstances, we don’t have any strong expectations, in other circumstances, we have these prior expectations, and we will weigh them.

And this offers us a mechanism for beginning to understand the emergence of phenomena like hallucinations, because it suggests that we don’t need to hypothesize some gross derangement of function, some horrible lesion somewhere.

We all define ourselves according to our internal models of the world.

We define our place in relation to others, in terms of shared models of the world. And if somebody’s building a model that isn’t shared by other people, that’s a very, very isolating experience, because their reality becomes different.

Now, I think science can come some way towards trying to look at mechanisms and develop clinical ideas of that, but ultimately, as is encompassed in the theme of today’s talks, really we need to think about experiences like this at other levels.

And that includes – I think very strongly – the arts.

My funding body, the Wellcome Trust, are very keen on getting their scientists to work with artists, and they’ve given me a number of fantastic opportunities to discuss these ideas with artists.

One example of that was putting me together with a writer, dramatist, and filmmaker, Julian Simpson, who deals a lot of the time with the idea of a brain trying to construct a reality out of sensory inputs.

And a consequence of this discussion and collaboration, although I can’t claim much credit for it at all, was a play that he wrote called “Fugue State,” which actually has already won a few BBC drama awards.

The other collaboration the Wellcome encouraged me with and one I would have never really predicted is with a video game design company, who approached me, because they want to make a video game about an 8th century Celtic warrior who suffers from certain experiences of psychosis.

Well, I was skeptical initially, but having gone to meet them, it actually became very clear to me that they were trying in a very respectful, and sincere, and honest way to try and recapture some of these experiences.

So we’ve had a number of meetings where we’ve got together with them and with a wonderful team at Recovery East led by the magnificent Tracy Bartlett, who are a group of individuals who have had experiences of mental illness and who are working towards recovery and are recovered in many cases.

They were kind enough, generous enough, and indeed, brave enough to discuss their experiences with the team at Ninja Theory and me.

And a consequence of that is that the game is being developed around these experiences, and Ninja Theory have very kindly given me a clip of film that I just like to leave you with.

This is some video from the game itself and some sounds that are really based upon the discussions that we’ve had.
(Video)

(Man) Coward.
(Woman) They’re coming.
(Man) Coward. Coward.
(Woman) They’re coming now. They’re coming.
(Multiple voices) They’re watching. They’re watching. They’re watching.
[Sometimes the world appears like a kaleidoscope. It can be beautiful.]
(Multiple voices) Out! Get out. Get out. Out! Get out.
Get out of here. Get out of here. Get out. Get out of here. Get out.
(Video ends)

Paul Fletcher: So this is still very much work in progress, but I hope it leaves you with the impression – åwhich I intend to create – which is talented artists can say more in two minutes about this than I could probably say in an entire series of lectures.

So thank you very much.

 

 

 

 

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The Spoils – Massive Attack Ft. Hope Sandoval


I got that feeling, that bad feeling that you don’t know
I don’t even know her but I hope that she comforts you tonight
Nobody here that keeps you in the shade and ever owned you
Some sentimental tears or someone else’s girl that drips away
But I somehow slowly love you
And wanna keep you the same
Well, I somehow slowly know you
And wanna keep you away
I got that feeling, that bad feeling that you don’t know
I don’t even know her but I hope that she comforts you tonight
And I somehow slowly love you
And wanna keep you this way
Well, I somehow slowly know you
And wanna keep you away, away
And I somehow slowly love you
And wanna keep you this way
Well, I somehow slowly know you
And wanna keep you
But I somehow slowly love you
And wanna keep you the same
Well, I somehow slowly know you
And wanna keep you away

Songwriters: Stewart Neville Jackson / Dan Jones / Grantley Marshall / Hope Sandoval
The Spoils lyrics © Kobalt Music Publishing Limited
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This is America – Childish Gambino


This.
This is America (woo, aye)

Yeah, yeah, yeah, yeah, yeah
Yeah, yeah, yeah, go, go away
Yeah, yeah, yeah, yeah, yeah
Yeah, yeah, yeah, go, go away
Yeah, yeah, yeah, yeah, yeah
Yeah, yeah, yeah, go, go away
Yeah, yeah, yeah, yeah, yeah
Yeah, yeah, yeah, go, go away
We just wanna party
Party just for you
We just want the money
Money just for you
I know you wanna party
Party just for me
Girl, you got me dancin’ (yeah, girl, you got me dancin’)
Dance and shake the frame
We just wanna party (yeah)
Party just for you (yeah)
We just want the money (yeah)
Money just for you (you)
I know you wanna party (yeah)
Party just for me (yeah)
Girl, you got me dancin’ (yeah, girl, you got me dancin’)
Dance and shake the frame (you)
This is America
Don’t catch you slippin’ up
Don’t catch you slippin’ up
Look what I’m whippin’ up
This is America (woo)
Don’t catch you slippin’ up
Don’t catch you slippin’ up
Look what I’m whippin’ up
[Verse 1: Childish Gambino, Blocboy JB, Slim Jxmmi, Young Thug, & 21 Savage]
This is America (skrrt, skrrt, woo)
Don’t catch you slippin’ up (ayy)
Look at how I’m livin’ now
Police be trippin’ now (woo)
Yeah, this is America (woo, ayy)
Guns in my area (word, my area)
I got the strap (ayy, ayy)
I gotta carry ’em
Yeah, yeah, I’ma go into this (ugh)
Yeah, yeah, this is guerilla (woo)
Yeah, yeah, I’ma go get the bag
Yeah, yeah, or I’ma get the pad
Yeah, yeah, I’m so cold like yeah (yeah)
I’m so dope like yeah (woo)
We gon’ blow like yeah (straight up, uh)
[Refrain: Choir & Childish Gambino]
Ooh-ooh-ooh-ooh-ooh, tell somebody
You go tell somebody
Grandma told me
Get your money, Black man (get your money)
Get your money, Black man (get your money)
Get your money, Black man (get your, Black man)
Get your money, Black man (get your, Black man)
Black man
This is America (woo, ayy)
Don’t catch you slippin’ up (woo, woo, don’t catch you slippin’, now)
Don’t catch you slippin’ up (ayy, woah)
Look what I’m whippin’ up (Slime!)
This is America (yeah, yeah)
Don’t catch you slippin’ up (woah, ayy)
Don’t catch you slippin’ up (ayy, woo)
Look what I’m whippin’ up (ayy)
[Verse 2: Childish Gambino, Quavo, Young Thug, & 21 Savage]
Look how I’m geekin’ out (hey)
I’m so fitted (I’m so fitted, woo)
I’m on Gucci (I’m on Gucci)
I’m so pretty (yeah, yeah)
I’m gon’ get it (ayy, I’m gon’ get it)
Watch me move (blaow)
This a celly (ha)
That’s a tool (yeah)
On my Kodak (woo, Black)
Ooh, know that (yeah, know that, hold on)
Get it (get it, get it)
Ooh, work it (21)
Hunnid bands, hunnid bands, hunnid bands (hunnid bands)
Contraband, contraband, contraband (contraband)
I got the plug on Oaxaca (woah)
They gonna find you that blocka (blaow)
[Refrain: Choir, Childish Gambino, & Young Thug]
Ooh-ooh-ooh-ooh-ooh, tell somebody
America, I just checked my following list and
You go tell somebody
You mothaf***as owe me
Grandma told me
Get your money, Black man (Black man)
Get your money, Black man (Black man)
Get your money, Black man (get your, Black man)
Get your money, Black man (get your, Black man)
Black man
One, two, get down
Ooh-ooh-ooh-ooh-ooh, tell somebody
You go tell somebody
Grandma told me, “Get your money”
Get your money, Black man (Black man)
Get your money, Black man (Black man)
Get your money, Black man (Black man)
Get your money, Black man (Black man)
Black man
You just a Black man in this world
You just a barcode, ayy
You just a Black man in this world
Drivin’ expensive foreigns, ayy
You just a big dawg, yeah
I kenneled him in the backyard
No probably ain’t life to a dog
For a big dog
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Trying to control the mind is like trying to flatten out water – Prince Ea



Trying to control the mind is like trying to flatten out water

Prince Ea

So your mind is outta control, huh?
You wanna control the mind?
Well, guess what?
You can’t do it.
Nobody can do it.

Trying to control the mind is like trying to flatten out water
you just make more waves.

because that’s the nature of the ocean,
it has waves
it has crashing.

You don’t say:

“there should be no waves in the ocean”

Well, the natural state of the mind is
full of thought,
mental noise
Once you accept that
the easier it will be to go beyond it.

Because you are not the mind,
you have a mind.
If you were the ocean why would you identify as a wave?
It’s just a wave.

Well, you are the at which observes
[thoughts.]
Stop identifying as thoughts
It’s just a thought.

And what is every thought made of?
Nothing.

You bring it to life
with the attention you give it.
The ones we have trouble with
are the ones we keep putting our attention to

Stressful thought come like a knock on eth door
and you keep lett’n em in
or you say:
NO-NO-NO-NO!
I don’t want you to come, in I want you to stay out.
And that makes them knock even louder.

So both aversion and attraction
feed, and multiply
thoughts.
The secret is
just don’t mind the mind.

Know that this is eth natrual state of teh mind.
Don’t feed it.

You do that not by control..
Just hold your ground
and the thoughts will
go away.

….

stay as you are
the silence between two thoughts…

 

 

 

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New York’s ‘Parachute’ programme for people with acute mental distress lands in the UK


New York ‘Parachute’ programme for people with acute mental distress lands in the UK

A radical new approach to psychosis that has succeeded in breaking the cycle of hospitalisation for patients in New York is about to be piloted here.
Leslie Nelson, a peer mentor with the New York City Parachute programme, says sharing experiences serves as an inspiration for participants.
Photograph: Tim Knox for the Guardian

Earlier this year Crystal Gonzalez, 25, started hearing voices. “I forgot that this is reality,” says Gonzalez, who lives with her mum and sister in the South Bronx, in New York City. Gonzalez has been diagnosed as bipolar, and as having a borderline personality disorder, histrionic personality disorder and obsessive compulsive disorder (OCD). Since the age of 14, her trips to the psychiatric ward had been routine.

She is not alone, mental distress is related to one in every eight emergency department cases in the US. This translates into nearly 12m visits every year, according to the Agency for Healthcare Research and Quality, an independent thinktank. Spending on these patients was $38.5bn (£24.9bn) in 2014, double what it was in 2003.

Earlier this year, Gonzalez’s therapist told her about another option to hospital. She went instead to a Parachute NYC respite centre – one of four across New York’s five boroughs. It is at the heart of a radical approach to psychosis that is attempting to end the cycle of hospitalisation across the city and is about to piloted in the UK.

Established in early 2013 by the New York Department of Health and Mental Hygiene (DHMH), the Parachute programme’s approach is “open dialogue”, in which a team of therapists and social workers encourage patients and their families to develop their own route to achieving recovery. Practitioners say the approach rejects hierarchy, encouraging equal and open dialogue between everyone in the group. It isn’t about getting “better”, but learning to live with acute distress and developing ways of managing it.

Open dialogue was developed in the 1980s in western Lapland by the Finnish psychologist Jaakko Seikkula. Within a few years, this remote area of northern Europe went from experiencing one of the worst incidence rates of schizophrenia in Europe to having the best documented therapeutic outcomes in the western world. One study showed that after two years of starting therapy more than 80% of participants had no noticeable psychotic symptoms.

The Parachute NYC programme is the first time open dialogue has been implemented in a major urban environment. In addition, it has pioneered peer support as part of the mix. Peer mentors help create a shared experience, says Leslie Nelson, 52, who works as a full-time paid peer in one of Parachute’s mobile open dialogue teams. “It’s just an amazing process for so many of us. Because the person locks on to you. They ask me: ‘You were like this?’ They can’t believe where I am now and they’re inspired by that.”

Gonzalez says of the peer mentors: “They give you tools, they go into their own lives and tell you about their struggles. That gives you strength because some of these people have gone through way worse than you have and they are able to live with it.”

In New York, all the indicators seem to show that the programme is meeting its professed aims: to save money and reduce rates of hospitalisation. Parachute is funded by a $17.6m, three-year grant from New York State and is run by separate providers including Riverdale Mental Health Association and Community Access. According to the most recent figures, it has served around 900 people in its respite centres and a further 700 people through its four mobile treatment teams, who travel to people’s houses and meet their family over a period of a year. In addition, 20,000 people have accessed its peer support helpline. Of its clients, 92% have previously used mental health services, two-thirds have had an inpatient hospitalisation and 77% have gone to A&E in the last five years.

The DHMH estimates that for every patient who has used the service, it saves $13,500 a year by keeping them out of hospital. Following its success, the mobile teams have secured state funding to continue working for another two years, while providers say patients will soon be able to pay for a stay in one of the respite centres through Medicaid, the US social health programme for people with limited incomes.

Research to be published later this year by the Nathan Kline Institute, a New York-based mental health thinktank, also shows there’s been a noticeable increase in the quality of life for people who have gone through Parachute.

These ideas are now going to be tried in the UK where community mental health services are poorly funded and overstretched. NHS trusts in Kent and Medway, Nottingham, North East London and North Essex are planning to launch a £500,000 pilot next year.

“Parachute is a really good example for us to follow,” says Russell Razzaque, associate medical director at the North East London NHS trust who is leading the UK programme. “The numbers in Finland look great, but Parachute in New York shows it works in a demographic that’s more similar to the one we work in.

“There’s a realisation that our current way of working just isn’t sustainable,” Razzaque adds. “We have more and more people within our services who are chronic and in here for 10, 20, 30 years, so we have a big in-door and a very small out-door.”

The pilot hopes to initially serve about 200 people. Razzaque says that as well as saving money, he wants to create a system which is kinder to patients and allows people to make decisions for themselves. “We really need our services to be more focused on getting people to stand on their own two feet,” he says.

“It’s challenging work, it’s a big shift, a big departure. Right now we are just slapping people with a label saying we’re going to have to look after you for the rest of your life,” he says. “Open dialogue suggests there might be a different way of treating people. Let’s see if that’s doable.”

Back in the Bronx, Gonzalez hasn’t been back to hospital since her two-week stay at the Parachute respite centre three months ago. She says that’s the longest time she’s been away from a psychiatric ward since she was 14. She’s even thinking about training to become a peer mentor. “They made me feel empowered, they made me feel good about myself,” she says. “It’s something I think I could do for other people. It’d help me become a person again.”

Original:

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How the modern world makes us mentally unwell


From School of Life,

Some of the ways that modern world we’ve built for ourselves and each other leads to so many of us struggling and becoming un-well.
It’s so prevalent that we had to invent a name to call how we struggle “mental illness” so we can talk about that and have more names to call each other instead of addressing the root cause.

It’s really not hard to understand why so many of us struggle in ways that sometimes get called “mental illness”.

Posted in bad things happen and they fuck you up, Emancipate yourself..., Ideas, making sense of "mental illlness", sh!t is f#cked, what's going on? | Tagged | Leave a comment

Voices Inside My Head -Ambersunshowers


 

 

 

 

 

 

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all the shit that happens after the-shit-that-happened


Whether a person is left traumatized has less to do with the-shit-that-happened than it has to do with all the shit that happens after the-shit-that-happened.

Werd.

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Madness, yet there is method in it… Vitor Pordeus


The world needs more Vitor Pordeus.

 

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One effect in common…


Psychiatric drugs, it seems, have one effect in common:

Rendering the people in our life incapable
of any response
other than
asking :
Have you taken your meds?

one effect in common... 1

 

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