2014 - Verslag studiedag
Report of the annual conference of ISPS Netherlands Flanders held to celebrate the retirement of Dr. de Pater and following the visit of Prof. Louis Sass to the Netherlands.
The annual conference of ISPS was held on October 30. Travelling all the way from Brussels to Rotterdam for the occasion, I was lucky to be just in time for the core message of Dr. de Pater’s convincing discourse. She notes that someone experiencing psychosis often starts communicating in an incomprehensive way. This renders interaction with others more difficult, she says, and as such it gets in the way of getting better. Dr. de Pater claims that patients might be doing this as part of a protection strategy, since words can hurt. “The tongue can contain a deadly poison and we are aware of that.” By communicating incomprehensively, we can protect people close to us, for example against words that might hurt them or against the intensity of our emotions. We also want to protect ourselves, against interference of those who wouldn’t understand anyway or maybe even against reality itself. Someone else’s power, his capacity to not fall apart, thus gives us freedom of speech, dr. de Pater explains. By offering security, you can start communicating again in a real way and it is this authentic communication that is a first and necessary step to getting better.
My thoughts drift to my own manic speech in some distant past. Dr. de Pater would have hold her own in the face of all such nonsense, that is for sure. With more than 30 years of experience she concludes that a safe battle works. “But not only a safe battle,” she continues. Also acceptance and striving for what is of value in life (ACT), tuning in to your body (sensoric integration therapy), the direct experiencing of another living creature (as with equitherapy), paid work and interpreting your own life history through theatre performances all help in getting better. As such, Dr.de Pater offers a nice introduction to all speakers that are up next.
Dr. Lot Postmes aks whether the disintegration of the self which is characteristic for psychosis, could relate to the disintegration of sensory perception. Contradictory sensory information leads to perceptual incoherence, which in turn leads to distortions of the self. Delusions and hallucinations all help patients reduce the perceptual incoherence (and with it also distortions of the self). Seen this way, they offer an advantage to the patient, be it one that comes along with a disadvantage: poor reality testing. Could perceptual coping strategies thus help recover from schizofrenia? It is a fascinating thought.
In any case, an interesting finding seems to confirm Dr. Postmes’s theory. In people born with blindness, the risk of suffering from schizofrenia is significantly smaller than in people who are not blind. This holds true, in spite of a greater risk to all other mental illnesses. With one of the senses missing, the intersensory balance improves, which makes all the difference.
After Dr. Lot Postmes, Dr. Jos De Kroon introduces Dr. Ross White. With some thought provoking pictures and quotes he introduces the audience to the intriguing world of Acceptance and Commitment Therapy (ACT). The goal of ACT is to help people get more psychological flexibility. In doing this, one does not presuppose that people have a “broken” brain. The assumption is that people can get stuck and as such, can get unstuck. In a clear presentation he explains how ACT is based on three pillars: being present in the here and now, being open to experience and doing what matters. Where the first two pillars correspond to what is called mindfulness, the third pillar boils down to clarifying your values and living according to those values. Being mindful alone does not suffise to get better, Dr. White explains. Where mindfulness is the means, doing what matters is the end.
Prof. Sass brings us a fenomenological approach to delusions. The DSM describes delusions as the result of poor reality testing. This isn’t quite certain, claims Dr. Sass. One could also see a delusion as a radically different way of perceiving, an extraordinary way of being in reality. It’s this important point that he wants to confer during his presentation. This is shown through the quotes he uses, which are derived both from literature as from his correspondence with Sophie, one of his patients. Sophie has a beautiful way of writing and knows how to vividly describe what’s happening to her during her psychosis. It’s almost as if she’s sent to parallel worlds. During a delusion both her beliefs and her knowings become dislodged from each other. “And no matter my efforts, I can’t make them connect again”, she says. Dr. Sass quotes Schreber who states that hallucinations show him insights that are deeper than those from other people. Dr. Sass speaks with a deep respect for his patients. He’s a man who clearly hears what they are saying, who wants to understand and thus actually listens. When later I ask him during lunch what his main motivations were to study psychosis, he tells me about one of his friends who was diagnosed with schizophrenia. The fact that really moved him was the contrast between the fascinating experience his friend was going through and what was made of it in mental health care. With all of his work he’s provided the mental health care with an answer of what he thinks about their approach.
In the afternoon we were provided with workshops given by the speakers of the morning. In addition to that there was also a presentation with equestrian therapy as a subject, provided by Natalie Bryssinck. She works with psychiatric patients and explains how she has seen little miracles happen through working and having contact with a living breathing animal. The interaction between client, horse and therapist can thus provide us with nice results. The beauty of this interaction is the basic way you’re being confronted with your own thoughts, feelings and actions. The horse doesn’t judge, it only shows what it feels through your presence and actions. In this way there’s no room for psychotic preoccupations, you have to focus on the reality around you. This focus enables you in time to reconnect to old strenghts and talents. Natalie is very enthusiastic about seeing people believing more in their own abilities through repeating the exercises during a extended period, it gives people’s self esteem a well needed boost. You could clearly see among the participants that Natalie’s talk made an impression. There was even a woman who was scared of horses who wanted to come by and see for her own the effect this therapy has on her!
During his ACT workshop Dr. White submits us to a cross examination. What are your values? Imagine: your friends are toasting on your 50th birthday. What would you want them to say about you? Interesting, but at my 30th my 50th seems already too close for good comfort. Instead I imagine my own retirement party. I discover that I wouldn’t mind to have a similar one to Margreet in the form of a conference. The fact that I’m not satisfied in my current job becomes even more clear because of this. Dr. White doesn’t stop there and robs a few more of our illusions. We see ourselves as highly psychologically flexible, but after filling in the flexibity scale we know better. Are you afraid of your own emotions? Are you afraid of your wishes and dreams? That is the opposite of psychological flexibity . It’s what stops you from leading a happy life and becoming aware of that is a first step towards it. Dr. White makes a point. ACT makes a point. An important point at that.
The people who attended the ACT workshop, missed out on the performance “Wieisernougek, of ik is een ander” (“Who’smad, or I are someone else”). In this piece of theater patients perform together with professional actors to show us their life stories. Several people told me later that the performance was very intense and emotional. You really were sucked into the feelings that someone was experiencing during intense moments of their lives. And maybe even more importantly, it wasn’t shown in a rose tinted way. Both the hardships and problems aswell as the tender helpfull moments were shown in a non distorted way.
The conference was closed off with a reception in honour of Dr. De Pater. “I might be retiring as an active mental health care professional, but that CERTAINLY doesn’t mean that I’m retiring from the field” she lets us know in a fierce way. Retirement only means that she will have more time for initiatives to change the current system (and her grandchild). I encounter a young man who used to be a client of hers. “Has she been able to help you?” I ask. “Well, now I’m doing really good”, he says, “ but the important thing is that you learn to help yourself.” He’s completely right and I laugh, because I’ve heard so many stories of fellow clients that they were robbed of this precise fact during their therapy.
We drink another glass in the company of the Red Hat Society: a gathering of ladies in neat outfits, with red designer hats. Dr. de Pater, who’s actively going from one group of people to the next, is also a member of this band of friends. She might be free of any diagnoses, but that she’s extrodinary that’s a fact we can’t deny. We raise our glasses again: to a succesfull conference, to psychological and social approaches to psychoses and to the dependant defenders of those approaches.
Griet Daemen 'hands on' expert (and with additions of Davy De Geeter living coach at Zeeuwse Gronden)
Powerpoints en interview met Louis Sass door Mark Leegsma in Deviant, tijdschrift tussen psychiatrie en maatschappij nr 83