Last week, Zsuzsanna Chappell and I presented together at the Philosophy SIG Conference for philosophers and psychiatrists. I’ve written about this before: We discussed a problematic bias for normalcy which shows up from time to time in psychiatric and psychological treatment.

The mental health care system doesn’t explicitly value normalcy for normalcy’s own sake. Explicitly, the goal of treatment is to make the patients feel better and/or become more “functional” – be able to work/study, or at least take care of their hygiene, feed themselves, and pay their bills. But some decisions and treatment methods are hard to explain in terms of wellbeing and function. Examples we brought up are first psychologists who advise people who self-harm to use “alternatives to self-harm” instead – but the “alternatives” actually consist of self-harming as well, in ways that might cause the person more harm than what they did before, only the new methods leave no marks. A person who cuts their arms, which is clearly painful but simultaneously gives the person a temporary sense of relief (which is the reason they do it), might be advised to eat chili fruits instead, or wear rubber bands around their arms which they can snap. Things like these can often be more painful, both temporarily and because the sense of relief the person used to get through cutting remain absent when they eat chilis and snap rubber bands on their arms, but they look more normal without cuts, and the new behaviour seems less weird and frightening to other people.
We further talk of many psychiatrists’ insistence on having all psychosis patients on meds. There are obviously many patients who want to be on meds, because their psychoses are frightening, and meds which suppress their symptoms make them feel better – nothing strange about that. What’s interesting is how many psychiatrists (not all, but many) react to patients who make a different judgment. There are psychiatric patients who judge that all things considered, it’s better to be unmedicated, even though this might mean relapses and hospitalization from time to time, which is obviously no fun. They judge that being unmedicated is still less bad than being on meds, because they suffer so horribly from the side effects. These patients have made a rational judgment where they weighed the pros and cons of both options, but they nevertheless often have a hard time getting psychiatry to listen to them, and are often coercively medicated – into a condition of suffering and dysfunction. What can explain these psychiatric judgments? Perhaps that the non-psychotic but suffering patient still seems a little more normal than someone who occasionally freaks out and goes psychotic, and has to be hospitalized for some time.

We discussed more cases than these: if anyone is interested you can email me, and I’ll send you our abstract and powerpoints.

Thursday this week, I’ll present “Two methods for dealing with bedrock loss” at the Too Mad to be True conference. My presentation there ties in with the psychosis part of Zsuzsanna’s and my presentation, since it’s about methods for handling the fundamental uncertainty about everything in the whole world which might hit you in a state of psychosis. The reason we need methods, strategies and coping mechanisms for psychotic problems is precisely that so many of us aren’t helped by meds: either because we’re “non-responders” (it’s estimated that standard medication fails to repress symptoms in around 1/3 of all psychosis patients – some of them are still helped by Clozapine or combinations of antipsychotics and mood-stabilizers, but far from all), or because we can’t stand the side-effects.
A method often taught to psychosis patients by therapists is “reality testing”. If weird thoughts or ideas strike you, you see weird things etc., you should ask yourself what evidence you have for your beliefs being true and your experiences being real. For some psychosis patients, this method works well, but not for everyone, and not for me. This is because every chain of evidence eventually leads back to things we just take for granted, stuff we just know. I’m talking about very basic stuff here: not the kind of things that science questions and investigates, but scenarios that philosophical sceptics dig into. In order to prove anything at all with scientific or common-sensical-sciency methods, we must already presuppose that, for instance, the entire world is not a Matrix-like illusion, but that we have access to reality in the first place. If you’re not certain of anything at all anymore, how do you handle your weird experiences? I talk about first choosing what to believe in the spirit of William James, a strategy that I’ve had some success with in the past, but which unfortunately demands enormous amounts of willpower and becomes exhausting in the long run. Second, I talk about a more Pyrrhonian-sceptical approach where I just try to roll with everything, not caring too much about what’s real or not, which is something I experiment with more and more, and believe might be a more long-term sustainable method.