Saturday, October 17, 2020

Understanding psychosis

At least the new guide Understanding psychosis: Voices, visions and distressing beliefs is clear that psychotic experiences do not result from a brain disease. The document has been edited by Anne Cooke from the original British Psychological Society (BPS) publication Understanding psychosis and schizophrenia. Anne was also one of the co-editors of the BPS report on Understanding depression, which I defended as a helpful, balanced report in my last post.

If only to show that I'm not merely a BPS acolyte, just to reiterate, I have been more critical of the psychosis report than the depression one (eg. see previous post). A strength of both reports is that they provide personalistic explanations of mental health problems, taking a holistic perspective rather than narrowly focusing on the brain. But I don't think, for example, that the psychosis report makes clear that psychotic symptoms can occur in delirium and dementia (see eg. previous post). Nor that psychosis may well not be associated with people asking for help because they have no insight into their problems. For example, it does not distinguish dissociation from psychosis (see eg. another previous post). 

Another strength of both documents is the attempt to explain mental health problems in everyday language. Psychiatry is not an exact science and therefore controversial, and unfortunately debates can become polarised. I would like to see more focus on the BPS position expressed in both documents that mental illness is not a brain disease (see eg. my Lancet Psychiatry letter and previous post). 

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