Creating our own theoretical frameworks and evidencebase

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Creating our own theoretical frameworks and
evidence-base

• Dr. Jan Wallcraft

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Some existing and emerging theoretical frameworks

• Psychosocial model
• Crisis model
• Trauma model
• Psychospiritual model
• Self-advocacy/empowerment model
• Experts by experience
• Self-management or coping frameworks
• Service user run services and research
• Strengths approach
• Recovery model

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Crisis model

• Caplan set out a model for primary prevention of
  mental disorder through recognition of and
  support for the needs of people in developmental
  or accidental crises. He defined a crisis as a
  short, intense period of psychological
  disequilibrium.
• Caplan investigated the cognitive and affective
  upset resulting from transitions between phases
  of life (developmental crises) and particularly
  those precipitated by unexpected accidents or
  life shocks (accidental crises).

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Crisis model

• Caplan outlined a basic theory of human needs,
  hypothesising that healthy personality
  development requires continual supplies of
  physical, psychosocial and socio-cultural
  necessities commensurate with the persons level
  of growth and development.
• Psychosocial needs, he suggested, include the
  need for continuing relationships with
  significant others, the exchange of love and
  affection, the need for limitation and control,
  and participation in joint activity.

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Crisis model

• Socio-cultural needs as described by Caplan
  include the need for social customs, norms and
  values, which provide stability and influence
  personality development.
• These provide the individual with a sense of
  external security, a place in the social
  structure, a path in life, a social role and
  rewards.
• He argues that the lack of psychosocial or
  socio-cultural supplies, or alternatively their
  overprovision (i.e. smothering relationships or
  too-rigid social structures), can be harmful to
  mental health.

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Crisis model

• A sudden loss of a needed aspect of life
  (bereavement for instance), or the threat of
  loss, can precipitate a crisis that can lead to
  acute changes in behaviour.
• Caplan suggests however that a crisis does not
  automatically lead to psychological damage. It
  also presents an opportunity for personality
  growth, if the person is able to find the
  internal and external resources to handle the
  situation and resolve it.

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Role of intervention crisis model

• A crisis is a turning point toward or away from
  mental disorder
• Successful intervention can happen if the person
  in crisis is offered the information, support and
  safe space to deal with the situation, find what
  resources they need to cope, learn new skills to
  prevent future crises, and integrate the
  experience.

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Trauma model

• Bloom argues that when people are subjected to
  repeated trauma this destroys the assumptions of
  personal safety that most people take for
  granted.
• Victims of trauma may perceive the world as no
  longer meaningful, or benevolent, and perceive
  themselves as worthless, helpless and hopeless
  (Bloom 1997 p.70).

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Trauma model

• They may become increasingly isolated from
  others, destroying their existing relationships
  and refusing to start new relationships.
• Trauma can become their central organising
  principle.

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Trauma model

• If children are exposed to danger repeatedly,
  their bodies become unusually sensitive, so that
  even minor threats trigger this entire sequence
  of physiological, emotional, and cognitive
  responses. They can do nothing to control this
  reaction it is a biological, built-in response,
  a protective device that goes wrong only if we
  are exposed to too much danger and too little
  protection in childhood or as adults (Bloom 1997
  p.72).

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Role of intervention trauma model

• Healing from trauma, Bloom argues, depends on
  creating a safe social setting in which people
  who had been traumatised could be heard,
  understood, come to understand what had happened
  to them, grieve and share their grief, and begin
  to integrate their new knowledge to reconstruct
  their world.

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Psycho-spiritual model

• A crisis may result from a persons attempts at
  spiritual exploration or from the denial of
  spiritual needs
• The developmental and transformative potential of
  a crisis should be emphasised.

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Psycho-spiritual model

• While there are many similarities between this
  approach and the crisis model, in the spiritual
  model there is a far greater emphasis on
  spiritual transformation and the normality of
  spiritual phenomena such as visions.
• Perry (1974) is a Jungian psychoanalyst and
  psychiatrist, who founded a pioneering crisis
  centre where young people experiencing a first
  episode of psychosis could be supported without
  medication.
• Perry argues that the more undesirable outcomes
  of crisis are less likely if a healing
  environment and intensive support are provided.

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Psycho-spiritual model

• Perry (1989) describes psychotic episodes as a
  renewal process, which temporarily overwhelms the
  individual in a prolonged visionary state. This
  he regards as nature's attempt to heal, rather
  than evidence of pathology. He concluded that
  psychic change does not happen smoothly, but is
  more like an earthquake or chaotic eruption.
• His (Perry 1974) view of a schizophrenic crisis
  is that the psyche is seeking to reorganise on
  new lines, and that far from suppressing
  psychotic ideas and images, these should be seen,
  like dream images, as communications from the
  psychic depths which can aid psychic
  regeneration, reintegration and the creation of
  new order.
• He noted that extreme turbulence tends to
  accompany profound changes in the psyche. People
  commonly talked of images of death and of the
  destruction of the world.

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Role of intervention psychospiritual model

• Perry (1974) argues that the role of the person
  who intervenes is to receive and work with
  whatever the person in crisis is communicating,
  rather than to treat their words and behaviour as
  symptoms of illness

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Self-advocacy/empowerment model

• an emerging psychiatric survivor or
  self-advocacy discourse of crisis which is
  distinct from professional and academic
  discourses.
• The key to this discourse is the power of the
  individual client, service-user or patient to
  self-define and to make choices
• This is a fundamental contradiction to the
  discourse of psychopathology, which locates this
  power with psychiatrists.

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Self-advocacy/empowerment model

• people tend to relate personal distress and
  tragedy in their lives to life problems such as
• abuse in childhood
• difficult pregnancy and birth
• loss of employment
• loss of relationship
• extreme stress
• suffering racism and violence
• feeling alone and excluded

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Self-advocacy/empowerment model

• The beliefs, thoughts and emotions people
  experienced are sometimes described by them in
  medical language, such as depression, mania,
  paranoia, or phobias
• this may be because they have been diagnosed in
  this way by a psychiatrist or because such
  language is now part of common parlance via the
  media.

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Self-advocacy/empowerment model

• Many people describe their experience as a
  breakdown.
• People describe
• thinking that they are being watched and talked
  about
• experiencing terrible fear and anxiety
• a compelling need to cry, hide and/or withdraw
  from life, escape, or commit suicide.

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Self-advocacy/empowerment model

• Some talk about having lost touch with everyday
  reality, having encounters with pure light and
  energy, talking to or becoming spiritual beings
  or feeling they had lost their self or spirit.
• Most people seem to have looked back in
  retrospect with a greater understanding of what
  had happened to them during their crisis.
• Some people with these experiences have
  explicitly stated their aim to promote a new
  discourse in which the collective voice of
  patients can emerge

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Self-advocacy/empowerment model

• This is a work in progress, but among its
  successes are
• Hearing voices movement
• Survivor run/led Crisis houses
• Service user run services
• Service user led research
• Influence on clinical psychologists, who in UK
  are working with Hearing Voices movement and
  developing functional approach as an
  alternative to diagnosis
• Strengths approach
• Recovery model

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References

• Anthony, W. (l993) Recovery from Mental Illness
  The guiding vision of the mental health service
  system, Innovations and Research,. 2 (3) 17-25.
• Bloom, S. (1997) Creating Sanctuary Towards the
  evolution of sane societies, New York Routledge.
• The British Psychological Society, Division of
  Clinical Psychology (2000) Recent advances in
  understanding mental illness and psychotic
  experiences, report, Leicester The British
  Psychological Society.
• Campbell, P. (1991) In Times of Crisis, OpenMind
  52, 15.
• _______ (1996a) Challenging Loss of Power, in J.
  Read and J. Reynolds (eds.) Speaking our Minds,
  Buckingham Open University.
• _______(1996b) What We Want from Crisis Services
  in J. Read and J. Reynolds (eds) Speaking Our
  Minds, Milton Keynes Open University.
• Caplan, G. (1964) Principles of Preventive
  Psychiatry, London Tavistock.
• Chamberlin, J. (1988) On our Own, London MIND.
• Coleman, R., Baker, P. and Taylor, K. (2000)
  Victim to Victor Working towards Recovery,
  Gloucester Handsell Publishing.
• Curran, C. and Grimshaw, G. (1999) Advance
  directives, Open Mind 99,.24.
• Curtis, T, Dellar, D., Leslie, E. and Watson B.
  (eds.) (2000) Mad Pride A Celebration of Mad
  Culture, London Spare Change Books

• Grof, S. and Grof, C. (ed.)(1989) Spiritual
  emergency When Personal Transformation Becomes a
  Crisis, New York G.P. Putnams Sons.
• Manic Depression Fellowship (1996) Inside Out a
  guide to self-management of manic depression,
  London Manic Depression Fellowship.
• Michaelson, J. and Wallcraft, J. (1997)
  Alternatives to the biomedical model of mental
  health crisis, Breakthrough, 1 (3) 31-49.
• Nelson, J.E. (1994) Healing the Split
  Integrating Spirit Into Our Understanding of the
  Mentally Ill, New York State University of New
  York Press.
• Pembroke, L. (ed.) (1994) Self-Harm Perspectives
  from Personal Experience, London Survivors Speak
  Out.
• Perry, J.W. (1974) The Far Side of Madness,
  Dallas, Texas Spring Publications Inc.
• Susko, M.A. (ed.) (1991) Cry of the Invisible,
  Baltimore Harrison Edward Livingstone.
• Wallcraft, J. and Michaelson, J. (2001)
  Developing a survivor discourse to replace the
  psychopathology of breakdown and crisis, in C.
  Newnes., G. Holmes and C. Dunn (eds.) This is
  Madness Too, Ross-on-Wye PCCS Books 177-190.
• Wallcraft, J (2003 )-On Our Own Terms Users and
  Survivors of Mental Health Services Working
  Together for Support and Change, The Sainsbury
  Centre for Mental Health