Monday, 15 January 2018

Risk of relapse in psychosis: facing the fear, resisting mental illness

My Opinion Piece published in Psychosis Journal, October 2017:
http://www.tandfonline.com/doi/full/10.1080/17522439.2017.1381757

In my experience psychosis was a journey from one place to another, necessary and transitional, in response to life trauma. I believe that we are all on the psychosis spectrum but only some of us will require respite and a break from everyday existence. Preferably a safe haven and secure base from which we can rise again, stronger than before, wiser and more able to face the next challenge that life brings to us.

Introduction

I first experienced psychosis three months after the birth of my second son in 1978, due to a number of factors, the main one being an induced labour, with oxytocin, and insufficient pain relief, additional stressor was living with in-laws, in one room, another family member unwell, and all of this combined to cause me difficulties in sleeping. Psychiatrists eventually came to visit and witnessed the situation, my stress, named it “puerperal psychosis” and said it was caused by “hormone imbalance”. I had insight and agreed to voluntarily enter a psychiatric ward for respite, only to be forcibly injected with Chlorpromazine, my breasts bound to stop the milk, separated from my baby son and his two-year-old brother. I was heartbroken at being so inhumanely treated but kept these thoughts to myself, eventually took the pills, conformed and was discharged within three weeks, back into the same situation at the in-laws farm. Within a year I had come off the antipsychotic, the psychiatrist had reduced the 400 mgs/day to 100, 4 × 25 mgs, and then I just stopped it, telling the doctor at the next appointment. He wasn’t happy but the deed was done and I made a full recovery, taking another year to build up my resilience, more confident and outgoing than before. In 1984 after another traumatic childbirth, my third son was born and within a week I again voluntarily entered the local psychiatric hospital.

Critiquing risk of relapse

In “Staying Well After Psychosis” Chapter One first page the authors write:

In psychological terms, relapse is a potentially devastating and critical life event with profound consequences for the emotional and psychological well-being of the person and their family or loved ones. Gumley and Schwannauer (2006 Gumley, A., & Schwannauer, Matthias. (2006). Staying well after psychosis. Chichester: Wiley. [Google Scholar], p3)

I would like to deconstruct this terminology from my lived experience of psychosis and recovery, caring for family members similarly. And attempt to reconstruct it by asking questions, providing a response through storytelling of lived experience. Is risk of relapse in psychosis more about the fear of (more) coercive psychiatric (drug) treatment? Is the concept a form of scaremongering, keeping the fear alive? Should there be a better way of reframing additional episodes of psychoses on a natural continuum rather than an illness paradigm? Do mental disorder diagnoses linked to psychosis hinder the well-being of those experiencing altered mind states as a way of externalising mental distress? 

Every time I experienced a psychosis, after childbirth then at the menopause, I voluntarily entered a psychiatric ward as an inpatient then was forcibly medicated with antipsychotics. After the first episode in 1978, I got off the drugs within the year and regained more confidence. By taking charge of my own mental health and well-being, deciding to recover, I increased my resilience and self-determination. A major influence in regaining independence was my Mother’s personal experience of psychiatric inpatient treatment and Schizophrenia diagnosis, many courses of ECT against her will and my younger sisters being taken into foster care when I was a teenager. This made me even more determined to resist any interference by social work agencies and mental illness labels.

We decided to have another child in 1984 and considered the risks but it didn’t put me off and I was optimistic of a better outcome. It wasn’t to be. My puerperal psychosis in 1984, which began in the maternity ward, was more swiftly acted upon by our local GP who was a friend and I was dispatched quickly into the same psychiatric ward, subjected to forced internal examination and neuroleptics. It was too much for my husband and he got a vasectomy, didn’t want me going through the same coercive psychiatric treatment again. I would have risked it, to have another child. So I was effectively sterilised at 32 years of age.

I found it easier to make a full recovery in the 1970s/80s than in 2002, because of only being on one antipsychotic compared to a cocktail of antipsychotic, antidepressant and “mood stabiliser” in the later episode and a diagnosis of Schizoaffective Disorder justifying the treatment.

Psychosis runs in my family, cancer doesn’t. I don’t see altered mind states at times of life trauma to be the major issue, rather it’s the treatment which can be re-traumatising, overpowering and iatrogenic. Therefore, I’m working towards researching and developing Safe Houses for Psychosis in Scotland, therapeutic alternatives to psychiatric hospital inpatient care.

Declaration of interest

No potential conflict of interest was reported by the author.

    Reference

  • Gumley, A., & Schwannauer, Matthias. (2006). Staying well after psychosis. Chichester: Wiley


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