Patients complained about the dismissal of their reality and the lack of attention in treatment to their experiences of psychosis, something they related to the quality of their relationships. They emphasised the impact of attitudes, thoughts and feelings of others in exploring and valuing their subjectivity and engagement, gaining much support and self-understanding through the relational matrix of the Movement. In this regard, they experienced a total neglect of inquiry in mainstream psychiatry through not being asked “how have you got here?”. Discouraged from reconnecting with own bodily and psychological experiences, they experienced the absence of an overarching ontology. In an exploration of his own recovery from schizophrenia, Coleman (2004) described how his ten years in treatment turned him from “a lonely and unhappy person into a perfect schizophrenic”. Whilst Isolated and depressed with treatment focussing upon maintenance through medication in treatment, his recovery took off when a fellow voice hearer reassured him “the voices were real” and meaningful. That sentence became his “compass
for... the direction I needed to travel, underpinning my belief in the recovery process” (p. 12).
The contrast in their experience of relationships within psychiatry and the Movement meant that patients understood themselves within the Movement whilst ironically, psychiatry became another hurdle in their quest. Rich accounts of becoming a person through gradual awareness of self-consciousness as a unity with multiple selves in health and psychosis, exist (Hegel 1978; Berthold-Bond 1995; Sartre 1943; Lysaker & Lysaker 2005; Stanghellini 2004; Sass et. al. 2013). An inner dialogue, the signature of human condition, (Hegel 1978) is a fundamental phenomenon of our self-consciousness and the way we recognise our internal divisions and yearning for unity or self-becoming. Phenomenologists have shown psychosis can be seen as the failure of such a process, a lack of integration of body, psyche and soul (Frattaroli 2001; Parnas 2011). Patients in my sample and other studies lamented the lack of safety in early relationships and its contribution to their psychic fragmentation (Romme et at. 2009; Strand & Tidefors 2012). Neglect of such experiences within psychiatry were contrasted with the support and attention paid to their inner process within the Movement, something that my patients saw as enabling in developing deeper relationships with self and others.
Crucial knowledge about humans being embedded within a mutually impacting flow of subjectivities (Stolorow & Atwood 1992) is sidelined in psychiatry. Developmental psychology (Stern 2005; Trevarthen 2005) has revolutionised our understanding so we know that repeated mutual and supportive interactions with carers form a cradle within which the human mind develops. Hobson (2004) explored the development of the self and thought in children, building on Trevarthen’s work and found nurturing on-going emotional interaction between the carer and baby to be essential. Mutual, emotional connections with carers allow babies to recognise the existence of other minds, such on-going supportive environment facilitating the development of their own mind and their ability to share perspectives. Winnicott’s spontaneous gesture (1960) is a similar integrating function to help the baby’s embodied self come into ‘being’ through repeated meetings with the (m)other. This provision of the integrating function through the (m)other’s holding keeps the existential fire in the belly burning. Without an injection of this fuel, the Winnicottian baby never quite comes to life so that in psychosis, the body remains deanimated and the spirit disembodied (Stanghellini 2004). Bion wrote about the baby’s use of the mother as the container (1962) in order to turn natural existential dread into manageable thoughts. I also read the phenomenological contextualists (Stolorow, Brandchaft & Atwood 1987; Stolorow, Atwood & Orange 2001) and the idea of dialogic/relational self (Sampson 1993) as emphasising the fundamental role of the other in our coming into being. The individual’s world of inner experience is embedded within the inner and outer worlds of significant others in a flow of reciprocal mutual influence. That reciprocity makes the dichotomy between intrapsychic and interpersonal realms obsolete as the outer becomes difficult to distinguish from the inner (Stolorow & Atwood 1992). In all these theories, our self comes into existence gradually and maintains itself through recognition within our relationships, making them ontologically essential. Social constructionists recognize our personalities and all mental distress including psychosis, as an outgrowth of such a process with individual, socio-cultural and biological aspects (Stolorow & Atwood 1992; Sampson 1993). My patients referred to their failed search for such relationships and understanding within their NHS treatment and pleasure at experiencing it within the Movement.
As psychological beings, capable others experienced in negotiating their ‘selves’ in the world are needed to grant us our licence to selfhood. Tragedy strikes when constitutional and
environmental factors mean the baby is surrounded by carers who did not gain their own licence or for other reasons, fail to pass on that ability. The aetiological roots of schizophrenia lie in an unconscious conflict within the child as well as in the family about allowing them to become an individual, leading to over-dependence and lack of development of a core personality (Searles 1993). The central conflict in the condition is speculated to be around the question, not of how to relate but whether to relate to others. Rather than allowing mutual co- existence, relating in this situation brings a threat of annihilation. Right from the beginning, repeated patterns of patients’ experiences mean that they develop pre-reflective organising principles of non-being and unreality of the self, in order to ensure the survival of the other (Stolorow, Atwood & Orange 2001). I understand the theory of High Expressed Emotion (Brown 1985), accepted in psychiatry as a family trait as related to this view. The common theme seems to be that of psychosis as the loss of opportunity to cohere as a self, due to interpersonal processes. When growth is unhealthy and insecure, psychosis may represent a desperate need for a reorganisation of our self, as Williams (2012) suggests. Several patients spoke of their “symptoms” as symbolic of the work they needed to do to reclaim their lives. Patients suffered in their early lives and during treatment through the inability of psychiatry to recognise the need and failure to provide such facilitating environments. With relationships crucial to the environment within which that work needs to be done, their neglect in psychiatry aggravated patients’ unconscious fears so the professional was experienced as a persecutor rather than a refuge. My data suggests that the dominant biomedical view may, tragically, have led to the continuation of psychosis if patients’ health-seeking impulse had not led them into the Movement.