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Rethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis Paperback – April 17, 2012
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"Every page of this book was exciting to me . . . This book should be a part of the training of every physician, psychiatrist, and pastoral counselor, and owned by the family and friends of every mentally ill person as well as the sufferers themselves." - Joanne Greenberg, bestselling author of I Never Promised You a Rose Garden
"A book of profound illumination both for the scholar and the person struggling for his or her psychical life. I highly recommend this book to all those who are touched by the psychotic experience, which really means all of us--and to find out why, just read this book!" - Kirk Schneider, Ph.D., author of Awakening to Awe
"Deceptively easy to understand, yet thought provoking and challenging, his work offers plausible reasons to overcome the too simple historical medical approaches that ignore the richness of the human experience and the positive potential inherent in one's journey through madness." - Ronald Bassman, Ph.D., author of A Fight to Be
"In a clear manner, Dr. Williams lays out the evidence for a 'paradigm shift' in our thinking that, at its core, would offer people who experience madness both hope and the knowledge that robust recovery is possible, and, with the right support, quite common." - Robert Whitaker, author of Mad in America and Anatomy of an Epidemic
"Rethinking Madness provides not only a compelling critique of the pessimistic and damaging 'medical model' that has dominated mental health services and research for far too long, it offers some hopeful alternatives." - John Read, Ph.D., Professor of Psychology, Editor of Models of Madness and the scientific journal Psychosis
About the Author
Dr. Paris Williams offers the very rare and powerful perspective of someone who has experienced psychosis from both sides--as a practicing psychologist and researcher, and as someone who has himself struggled with psychotic experiences. In his late 20's, while in the midst of a very successful career as a hang gliding instructor and competition pilot (winning a World Champion title and multiple National Champion titles), Paris Williams suddenly found himself plunged into a profound struggle with experiences that would have likely resulted in the diagnosis of a psychotic disorder. Fortunately, he managed to avoid becoming entangled within the psychiatric system, and he instead embarked upon a journey of healing and self discovery, working to resolve his own personal crisis while aspiring to support others going through similar crises. He has since spent over a decade deeply exploring both Eastern and Western understandings of mind and consciousness, studying intensive meditation from a number of different masters around the world, earning a Ph.D. in Clinical Psychology, working in numerous settings supporting people struggling with psychosis and other challenging and extreme experiences, and conducting a series of pioneering research studies at Saybrook University on recovery from schizophrenia and other psychotic disorders. He continues to work as a psychologist in the San Francisco Bay Area.
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Top Customer Reviews
Williams' critique of the medical-model is carried out thoroughly, with a firm basis in scientific evidence. The first part of the book includes a review of a lot of the current scientific literature on madness and concludes that there is very little evidence supporting the medical-model and a lot of evidence contradicting it. For example, the medical-model views things like schizophrenia as degenerative brain diseases. If that model were correct recovery would be impossible. There are, after all, no reported cases of people recovering from genuine degenerative brain diseases like Alzheimer's, but there are lots of cases of people recovering from schizophrenia (21) (41). Paris Williams also examines studies that suggest a strong genetic component to schizophrenia, he offers some critiques of those studies, and he cites a study that discovered that environmental influences (family dysfunction, etc.) have seven times more explanatory power than genetic predisposition (30). Williams also cites a study by the BPS that questions the validity of diagnostic categories like schizophrenia. There is almost no statistical clustering of symptoms which suggests that categories like "schizophrenia" might be social constructions (36-38). Williams also presents lots of evidence suggesting that the use of anti-psychotics is often more harmful than helpful in the long-term (42-57).
After critiquing the medical-model Williams summarizes a whole host of alternative models of madness. There is a lot of overlap between the various alternative models. They all tend to view madness as a result of seemingly irresolvable existential dilemmas. Many of the alternative models of madness see madness as part of the psyche's self-healing dynamics. A lot of the alternative models view madness as the psyche's last resort in attempting to deal with an unacceptable existential situation. In the third section Williams presents his own DUI model of madness which incorporates aspects of the alternative models presented in the second section. Williams sees a dialectic operating at the heart of our being between isolation anxiety and engulfment anxiety. As unique individuals we all have different windows of tolerance in relation to each and we swing between them. The psyche tries to maintain itself within its window of tolerance. There is also a tension between our standard cognitive constructs, which tend to reinforce our dualistic views about the world, and the ultimately non-dualistic nature of reality that manifests itself in "transliminal experiences".
Madness generally occurs when the dialectical tension between isolation anxiety and engulfment anxiety becomes unbearable, the window of tolerance shrinks to zero, and, there is a corresponding instability in a person's cognitive constructs, so that they become particularly open to transliminal experiences. Madness is the psyche's attempt to fundamentally alter a person's cognitive constructs in a way that will reduce the dialectical tension and the untenability of the person's existential situation. That is an overly simplistic summary of Williams' model that does not really do it justice. However, Williams' model is able to explain a lot that the standard medical-model is unable to explain. It is able to explain why there is a high recovery rate. It is able to explain why so many of the people who have experienced periods of psychosis claim that the experiences were ultimately beneficial in terms of their overall psychic health. It is able to explain why environmental factors are more predictive than genetic factors. It is also able to explain why the use of anti-psychotics often does more harm than benefit since they tend to short-circuit the psyche's natural healing processes.
Ultimately, there is still a lot of work that needs to be done in attempting to understand madness. Williams intersperses six case histories throughout the book to support his model. They are all quite interesting and Williams' model is able to make sense of a great deal of their experience. However, all the case histories were people who experienced a very precise period of onset for their psychosis and they were all people who ultimately recovered. There are, in other words, a lot of similarities in the case histories. I would like to see the case histories expanded to see how Williams' model would apply to people who do not fit that profile. I have a family member who has suffered from psychosis her whole life. I have talked to family members who have known her since she was a child. I asked them if there was ever a time when she was "normal", for lack of a better term, and they said no. There was not, therefore, any particular moment when her psychosis started to manifest itself. She has just always been that way, even when she was a small child. I am curious how her experiences would fit into Williams' model. I would also be curious to see how Williams' model would account for people who experience a specific period of onset but never successfully recover.
I would like to see Williams' model expanded to account for these cases. Any successful model of madness, of course, is going to have to be able to account for all the diversity in onset times, recovery rates, etc.. Part of the difficulty with models of madness is that they all tend to leave anomalies out. For example, there is some scientific evidence of brain abnormalities in schizophrenics. The problem with that evidence, as Williams himself points out in this book, is that some people who are schizophrenic do not have the brain abnormalities, and, I believe, though I could be remembering this part incorrectly, some people have them but are not schizophrenic. I think those kinds of anomalies suggest there is something wrong with the basic model. I am not suggesting that there is anything wrong with Williams' model. I think it would definitely be possible to work out Williams' model in a way that would account for people who did not have any particular point of onset or who never recovered. That to me, would be the next logical step. There is, obviously, still a lot of research to be done, but I think Williams' book is a great first step.
It was refreshing, affirming, challenging, and cathartic to take this journey through an understanding of psychosis that Dr. Williams has created.
From the initial intention of clarifying the terms and scope of the work, a clear and precise framework is constructed. Within this framework, the journey begins through a presentation of models, data, research, case studies, and myths (defined as "beliefs that are generally held within a society without generally being seriously questioned") concerning psychosis and recovery.
Each model is presented, summarized, questioned (seriously, with citations), and evaluated against the data, as well as the defined definition of Full Recovery. At the end of this trip through the previously explored territories, a new model is presented, and subjected to the same comparisons.
The restraint and humility present in the book was striking to me, and more striking in that I see it as a careful, meticulous, intentional, detailed, and highly organized presentation of Dr. Williams' intense passion. Often, this level of true connection and fiercely personal impact of topics such as this are easily dismissed by those who find the information hard to hear, much less digest and incorporate, due to the intense charge behind the words. I applaud Dr. Williams' restraint, and thank him intensely for the pages and pages of such impassioned writing I imagine must exist somewhere/when from which he distilled and extracted this presentation.
As one who made the journey through psychosis to Full Recovery as defined in this book, I also found it incredibly supportive to see so much data to support the conclusions which led to my own Full Recovery. Ten years ago I first heard about my 'chemical imbalance' and begin learning about myself and my process, and found little confirmation of the new Stories of Existence which have worked their way out into my worldview, I'm excited to see so much information in support of this type of model. And re-energized.
My excitement and relief at reading this book obviously place me squarely in the camp of those receptive to Dr. Williams' conclusions, so it's easy for me to shout 'YES!' and want others to relocate here. However, I arrived at this camp alone, exhausted, and confused, and have found it extremely vacant since. I am incredibly thankful to now have a resource with clear, detailed, EXTENSIVE references and citations concerning the strengths, weaknesses, correlation, effectiveness, etc. of different theories of psychosis. I can now point, speak: "Consider" and walk away when asked for my permit to camp here.
My personal experience also lines up with (influences, slants, drives) my interpretation of the data presented as showing the 'medical model' of psychosis to be the least empowering, most hopeless of the models, completely devoid of any solid ground on which to stake the flag of intention to recover. While the DUI model presented establishes a firm and fertile land for settlement. There is still much work to be done in this new place, and it is not made of sweetness and light (or is it?), the possibility is there to thrive, and that is enough.
By the end of my first journey through Dr. Williams' contribution to the understanding and treatment of psychosis, I was smiling at the thought of this paradigm 'catching on' and laughing at how much work it took to establish conclusions which seem obvious from the other side. Almost a 'gate-less gate' experience.
These conclusions, (my paraphrasing): That psychosis can be an intense, risky, powerful, transforming, and ultimately freeing experience if viewed with new eyes and treated with respect and compassion. That those who confront questions of their own existence and annihilation are on a journey, and the way out is through. That when this occurs in an environment which says such questions have already been answered, and the solution is to stop asking and just embrace the given answers, the process is hindered. That on the other side of this process is a life without the constraints which led to the confrontation in the first place. These provide a starting point for those who encounter this process, those who have been through it, and those surrounding it.
Thank you, Dr. Williams, for this vehicle, Rethinking Madness, which moves us Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis in Style!