Dutch professor of psychiatry and epidemiology, Jim van Os on Connecting to Madness at TEDxMaastricht – Transcript
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Jim van Os – Dutch professor of psychiatry and epidemiology
Actually, the main selection criterion for the TED Talk is that you have to be slightly crazy. And I distinctly remember that I wanted to say something important about it, but I’m getting a little confused because, you sir, I saw you touching your glasses just now. Whilst at the same time, the lady over there was distinctly scratching her nose. I saw you… And there is something going on between the two of you, some sort of communication. And I distinctly get an impression that you want to ruin my TED Talk. Is that true?
So, maybe some of you start to worry a little bit about my mental health. And maybe after my TED Talk you want to take me to the local hospital for a psychiatric assessment.
Now, let’s imagine, I tell the psychiatrist that apart from these delusional thoughts I’m also hearing voices. And that I haven’t been functioning very well for the last six months. By telling this, I will meet, likely, criteria for one of these, so called “schizo” diagnoses. Let’s say I meet criteria for schizophrenia, which is the prototypical diagnostic formulation for madness.
Now, my family, by this time, will be notified of this diagnosis. And since they don’t know what it is, they will start looking on the internet, what this condition actually is. And they’ll look in the most prestigious scientific journals. And they find that I have a devastating genetic brain disease, or a debilitating neurological disorder.
So, now they start to be really worried. And they start looking for the information about my likely prognosis. And they find that my prognosis is bad. I am totally disabled for the remainder of my lifetime. WOW! That’s scary, isn’t it?
But you will note that there is nothing in this terminology that actually allows them to understand, what is the matter with me. The information is disconnected from anything that we can understand as a mental function. What is offered is a stereotype, consisting of three things: A mystifying Greek name, an unproven hypothesis of a genetic brain disease and a hopeless view of outcome.
Meet my cousin Elizabeth. Elizabeth completed two university studies and is a witty and compassionate person, quite unlike me. And we were close, always. And we both ended up in psychiatry. However, me as a psychiatrist, and she as a patient. And over the last 15 years, she has worked very hard at her recovery — taking her medications, accepting numeral hospital admissions, and receiving a range of psychiatric diagnoses, including several of the “schizo” diagnoses.
And then, five years ago, there was this great moment, because she applied for a job and was accepted. But, when her employer found out about her diagnosis, he immediately tried to dismiss her. And when he found out he couldn’t, she was forced to disclose her diagnosis to the entire office. So nobody initially wanted to work with her.
But now, five years later, she has an exemplary work record. But because of the extremely negative expectations associated with psychosis, diagnosed people face an uphill struggle. A very few end up in paid employment.
So, why do I tell you this? Well, psychosis, schizophrenia, these are conditions that typically start in adolescence. There is widespread consensus that in order to recover from psychosis, you need a perspective of hope, a possibility to change. And I think, it is clear that the concept or the stereotype of psychosis as represented is devoid of exactly that – of hope and change.
So, can we do better? Well, a bunch of people got together, and this was really a mixed group of patients, professionals, relatives, and we asked ourselves the question: what do we really know about psychosis? Is schizophrenia really best represented as this stereotype of a devastating genetic brain disease? Or is schizophrenia something perhaps that is connected to human mental function, just like disorders of anxiety and depression are connected to human emotions? And if it is connected, can we reach young people to give them a message of hope and change?
So, to cut a long story short, let’s have a look at what we came up with.
[Video: Psychosis experiences. Everybody has them, and so do you. Throughout the day, we are exposed to stimuli that we hear, see, taste, feel and smell. Our brain helps us to transform this information into an image of the surrounding world. In other words, we translate external sensory information from our environments into an internal mental experience. Sensory translations are highly personal. For example, two people are walking through the woods at night. One watched a violent horror film earlier this evening, whereas the other did not. As a result, the one hears and sees rather different things, compared to the other. This is because powerful negative emotions, occasioned by the film, distort person’s interpretation of sensory perception. One can say, therefore, that this person is experiencing a mild psychotic event. Childhood adversities, cannabis use and genetic factors can trigger negative interpretations. This may cause you to feel that the world is full of threats. For example, you may start thinking that you are being stalked, or that people on TV are talking about you. Such ways of thinking are called delusions. You may also misinterpret your inner mental processes. For example, your thoughts can become so overpowering, that you interpret them as external voices or visions. As a result, you may hear voices or see things that are not really there. These experiences are called hallucinations. If perception of external environments or inner thoughts become psychotic, it is possible, with help, to learn, how to modify this. This is a learning process that many people with psychotic symptoms find profitable. PsychoseNet tries to facilitate this process. [Video ends]