Paris WilliamsRethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis

This is really an excellent book. It is one of the best psychology books I have ever read. I am a philosophy student but I am very interested in psychology, and the problem of mental illness, both for personal and purely intellectual reasons. It is clear to me that we still do not really understand mental illness very well and, I think, a correct understanding of mental illness would have huge implications in terms of our understanding of what it means to be human and what we are at a fundamental ontological level. I think, for example, that a correct understanding of mental illness would be extremely relevant to the debates taking place in philosophy of mind about the reducibility of the mental to brain states, the status of meaning, etc.. The medical-model of madness, which treats madness as a brain disease, is currently the dominant model of madness. This book offers a critique of the medical-model and then attempts to work out an alternative model of madness that is more in line with the evidence and with the actual experiences of those who have suffered through periods of psychosis.Williams' critique of the medical-model is carried out thoroughly, with a firm basis in scientific evidence. The first part of the book includes a review of a lot of the current scientific literature on madness and concludes that there is very little evidence supporting the medical-model and a lot of evidence contradicting it. For example, the medical-model views things like schizophrenia as degenerative brain diseases. If that model were correct recovery would be impossible. There are, after all, no reported cases of people recovering from genuine degenerative brain diseases like Alzheimer's, but there are lots of cases of people recovering from schizophrenia (21) (41). Paris Williams also examines studies that suggest a strong genetic component to schizophrenia, he offers some critiques of those studies, and he cites a study that discovered that environmental influences (family dysfunction, etc.) have seven times more explanatory power than genetic predisposition (30). Williams also cites a study by the BPS that questions the validity of diagnostic categories like schizophrenia. There is almost no statistical clustering of symptoms which suggests that categories like "schizophrenia" might be social constructions (36-38). Williams also presents lots of evidence suggesting that the use of anti-psychotics is often more harmful than helpful in the long-term (42-57).After critiquing the medical-model Williams summarizes a whole host of alternative models of madness. There is a lot of overlap between the various alternative models. They all tend to view madness as a result of seemingly irresolvable existential dilemmas. Many of the alternative models of madness see madness as part of the psyche's self-healing dynamics. A lot of the alternative models view madness as the psyche's last resort in attempting to deal with an unacceptable existential situation. In the third section Williams presents his own DUI model of madness which incorporates aspects of the alternative models presented in the second section. Williams sees a dialectic operating at the heart of our being between isolation anxiety and engulfment anxiety. As unique individuals we all have different windows of tolerance in relation to each and we swing between them. The psyche tries to maintain itself within its window of tolerance. There is also a tension between our standard cognitive constructs, which tend to reinforce our dualistic views about the world, and the ultimately non-dualistic nature of reality that manifests itself in "transliminal experiences".Madness generally occurs when the dialectical tension between isolation anxiety and engulfment anxiety becomes unbearable, the window of tolerance shrinks to zero, and, there is a corresponding instability in a person's cognitive constructs, so that they become particularly open to transliminal experiences. Madness is the psyche's attempt to fundamentally alter a person's cognitive constructs in a way that will reduce the dialectical tension and the untenability of the person's existential situation. That is an overly simplistic summary of Williams' model that does not really do it justice. However, Williams' model is able to explain a lot that the standard medical-model is unable to explain. It is able to explain why there is a high recovery rate. It is able to explain why so many of the people who have experienced periods of psychosis claim that the experiences were ultimately beneficial in terms of their overall psychic health. It is able to explain why environmental factors are more predictive than genetic factors. It is also able to explain why the use of anti-psychotics often does more harm than benefit since they tend to short-circuit the psyche's natural healing processes.Ultimately, there is still a lot of work that needs to be done in attempting to understand madness. Williams intersperses six case histories throughout the book to support his model. They are all quite interesting and Williams' model is able to make sense of a great deal of their experience. However, all the case histories were people who experienced a very precise period of onset for their psychosis and they were all people who ultimately recovered. There are, in other words, a lot of similarities in the case histories. I would like to see the case histories expanded to see how Williams' model would apply to people who do not fit that profile. I have a family member who has suffered from psychosis her whole life. I have talked to family members who have known her since she was a child. I asked them if there was ever a time when she was "normal", for lack of a better term, and they said no. There was not, therefore, any particular moment when her psychosis started to manifest itself. She has just always been that way, even when she was a small child. I am curious how her experiences would fit into Williams' model. I would also be curious to see how Williams' model would account for people who experience a specific period of onset but never successfully recover.I would like to see Williams' model expanded to account for these cases. Any successful model of madness, of course, is going to have to be able to account for all the diversity in onset times, recovery rates, etc.. Part of the difficulty with models of madness is that they all tend to leave anomalies out. For example, there is some scientific evidence of brain abnormalities in schizophrenics. The problem with that evidence, as Williams himself points out in this book, is that some people who are schizophrenic do not have the brain abnormalities, and, I believe, though I could be remembering this part incorrectly, some people have them but are not schizophrenic. I think those kinds of anomalies suggest there is something wrong with the basic model. I am not suggesting that there is anything wrong with Williams' model. I think it would definitely be possible to work out Williams' model in a way that would account for people who did not have any particular point of onset or who never recovered. That to me, would be the next logical step. There is, obviously, still a lot of research to be done, but I think Williams' book is a great first step.

I finished this book last evening. No, that is not entirely accurate. And in the spirit of this book, let me clarify my wording... I completed my FIRST journey through this book last evening. There will be more trips, both here and down many of the paths so well-documented in the bibliography and resources at the end.It was refreshing, affirming, challenging, and cathartic to take this journey through an understanding of psychosis that Dr. Williams has created.From the initial intention of clarifying the terms and scope of the work, a clear and precise framework is constructed. Within this framework, the journey begins through a presentation of models, data, research, case studies, and myths (defined as "beliefs that are generally held within a society without generally being seriously questioned") concerning psychosis and recovery.Each model is presented, summarized, questioned (seriously, with citations), and evaluated against the data, as well as the defined definition of Full Recovery. At the end of this trip through the previously explored territories, a new model is presented, and subjected to the same comparisons.The restraint and humility present in the book was striking to me, and more striking in that I see it as a careful, meticulous, intentional, detailed, and highly organized presentation of Dr. Williams' intense passion. Often, this level of true connection and fiercely personal impact of topics such as this are easily dismissed by those who find the information hard to hear, much less digest and incorporate, due to the intense charge behind the words. I applaud Dr. Williams' restraint, and thank him intensely for the pages and pages of such impassioned writing I imagine must exist somewhere/when from which he distilled and extracted this presentation.As one who made the journey through psychosis to Full Recovery as defined in this book, I also found it incredibly supportive to see so much data to support the conclusions which led to my own Full Recovery. Ten years ago I first heard about my 'chemical imbalance' and begin learning about myself and my process, and found little confirmation of the new Stories of Existence which have worked their way out into my worldview, I'm excited to see so much information in support of this type of model. And re-energized.My excitement and relief at reading this book obviously place me squarely in the camp of those receptive to Dr. Williams' conclusions, so it's easy for me to shout 'YES!' and want others to relocate here. However, I arrived at this camp alone, exhausted, and confused, and have found it extremely vacant since. I am incredibly thankful to now have a resource with clear, detailed, EXTENSIVE references and citations concerning the strengths, weaknesses, correlation, effectiveness, etc. of different theories of psychosis. I can now point, speak: "Consider" and walk away when asked for my permit to camp here.My personal experience also lines up with (influences, slants, drives) my interpretation of the data presented as showing the 'medical model' of psychosis to be the least empowering, most hopeless of the models, completely devoid of any solid ground on which to stake the flag of intention to recover. While the DUI model presented establishes a firm and fertile land for settlement. There is still much work to be done in this new place, and it is not made of sweetness and light (or is it?), the possibility is there to thrive, and that is enough.By the end of my first journey through Dr. Williams' contribution to the understanding and treatment of psychosis, I was smiling at the thought of this paradigm 'catching on' and laughing at how much work it took to establish conclusions which seem obvious from the other side. Almost a 'gate-less gate' experience.These conclusions, (my paraphrasing): That psychosis can be an intense, risky, powerful, transforming, and ultimately freeing experience if viewed with new eyes and treated with respect and compassion. That those who confront questions of their own existence and annihilation are on a journey, and the way out is through. That when this occurs in an environment which says such questions have already been answered, and the solution is to stop asking and just embrace the given answers, the process is hindered. That on the other side of this process is a life without the constraints which led to the confrontation in the first place. These provide a starting point for those who encounter this process, those who have been through it, and those surrounding it.Thank you, Dr. Williams, for this vehicle, Rethinking Madness, which moves us Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis in Style!

This was a great book to start my research into psychosis with. It supports all my intuitions in regards to the fundamental (spiritual) wisdom inherent within the psyche, and covers some basic ground in terms of the archetypal patterns involved in the process. When the psyche needs to reboot, it does so. This process should be honoured. The stale Western medical model for mental illness is a disgrace and should perhaps also, much along the lines of a psychotic experience, be rebooted on the collective level! My only criticism is that the study subjects were generally creative and spiritually oriented people who clearly had an inherent drive towards independent thinking and healing. How could less conscious people with a more profoundly destructive mental profile be helped? This is no doubt a question for the future.

This brings together strands of thought from a number of psychiatrists, psychologists and contemporary thinkers and examines the science and assumptions behind the medical model of schizophrenia. It is interwoven with fairly detailed case histories which are considered through the lens of the alternative paradigm he proposes and would make interesting reading not only for practitioners but also for individuals and families affected by psychosis.I give it four stars rather than five as I would have preferred to see more information on the implications for families coping with a diagnosis of psychosis, especially when, as is all too common, there is an unwillingness or inability to engage with professionals from either a mainstream or an alternative background.

On a par with previous purchases by Gary Greenburg and Allen Frances, giving excellent insight into the 'western medical model' of treating mental health issues, backed heavily by the pharmaceutical giants, who bamboozle their way in to medicate anything that remotely doesn't fit the western view of 'normal'. You name it, they will have a pill for it!!!.

This is an explorative experience of going beyond the 'norm' - who can say what is 'norm' - it allows further questions , a challenge to understanding.

This book is a remarkable counterpoint to the ‘medical model’ of biological causes and treatment of schizophrenia. There are also very handy definitions that help in articulating the otherwise elusive descriptions of the "schizophrenic" experience. Dr. Williams has taken tremendous effort to converge on the ideas presented and the effort shows. Having said that, each person's experience with the condition is idiosyncratic, each therapy may need customization. The individual’s willingness to see and experience the therapy for its benefits becomes critical.To be able to address the underlying causes needs great insight, is very personal and is likely to take a long long time, and quite unlike the quick turnaround times for success claimed both by some successful medical and some non-medical therapies. Symptoms may go, but the problems may remain. Given the actual span of time and learning generally required for complete ‘recovery’, I would call it part of the natural process of maturity, the wisdom of age and experience. This may be the position of the stand that - “psychosis is the natural process of the psyche.”The actual theories forwarded regarding the operations of our mind reminded me of Einstein’s analogy of the Universe as a watch. We can find ways to theorize how the insides work, but ultimately, the watch is un-openable, and its working may well be very different. As Dr. William says, the “map is simply not the same as the territory.” The book goes in to great detail on the different problem modes, hence getting to the solution mode required some dogged reading and understanding.The book rightly hits upon clarity and caring as keys to recovery. Much of how these keys get extended is correctly attributed to differences in approach by different cultures, leading to different outcomes and degrees of success. I am also able to relate to the proposition that the mind-set after ‘recovery’ is relatively enlightened and also a more compassionate one (After hitting rock-bottom, one would definitely get better). Being in India and interested in outcomes of therapies, I did find statistics stating incidence is far far lesser then originally concluded. One could keep in mind that mental illness was not an insurable condition in India up until 2017.I definitely agree that if there is no "distress" without taking medicine, it is ideal. But, for those who 'depend' on meds, the book is confounding: leaving a damned if you do, damned if you don't feeling. On the positive side, it may be a cue for caution and the need to be sensitive to medication regimes. If we want to completely reject biological bases and stop medicinal regimes, are we willing to sacrifice recoveries from beneficial psychiatry, that which does not overdose and is helping the person function, and therefore accept the probable fall-out as collateral damage?When insights develop and the person is able to imbibe psychoeducation, medicine may perhaps be substituted with counselling, very gradually while being aware of any feelings of distress or its absence. The enormous amount that the drug companies make is cited as one of the reasons why the medical model survives instead of psychological remedies. The question that I tend to consider is will we end up robbing Peter to pay Paul, extending the argument to make a complete switch to counselling?Anti-psychiatry or anti-medical models that do not distinguish therapy from quackery, in both alternative treatments and ‘conventional’ physiological treatment, are the issues here. There are unscrupulous practitioners in both these areas exploiting our generally misinformed public. We are yet to reach a stage where robust AI and ranking systems hopefully are able to differentiate genuine information and false claims. Until then, the churn caused by different insights, continue to help.