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I have
had a major turn around in my life. I have been
witness to the social adversity of a person who is
close to me, who consequently experienced a break
down, a diagnosis, and decades of medication. I also
experienced my own brief emotional trouble,
resulting from adverse conditions, but fortunately,
a very speedy recovery in the hands of a very
skilled therapist. It was during my own recovery
that I began to study and realized the relationships
between a person’s total social environment, the
skills they possess to deal with this environment,
and this persons mental health. I have since
observed this relationship over and over. My study
also revealed the possibility for change, which has
encouraged me to focus on helping those people with
the most troubling of diagnoses, particularly
psychosis and schizophrenia.
I have recently graduated with an Honours degree in
Psychology. I currently work for DRUG-ARM, a
government funded organization in Queensland
Australia, which deals with drug addiction and
experiences cases of drug induced psychosis. I have
voluntarily been spending time with consumers of
Integrated Mental Health Services, and the Bayside
Initiative Group in Brisbane. I have been the most
diligent of students in the philosophy and
psychotherapy of psychotic and other clinical
disorders and have completed workshops on Brief and
Hypnotic Techniques.
I was pleased to find this web page on “Direct
Confrontation”, to read about the insights and
experiences of Jack Rosberg, and the experiences of
other contributors. I am pleased to add another very
positive experience to this web page and hope that
any people who are experiencing psychosis or
schizophrenia, are able to access this kind of
approach, which offers the most promising of
outcomes that I am aware of. I have included a
summary of my experience with a person diagnosed
with schizophrenia, and their own experience of me
(written without viewing my summary) that was
written for this news letter. I’d like to thank TW
for his letter to me, and hope that my summary and
his letter inspire similar others to settle for
nothing less than a positive future.
If anyone wishes to correspond with TW, I will let
him know. He may be willing to use the internet
connection which his house mate has established.
James Le Lievre
jameslelievre@hotmail.com
Brisbane, Australia
__________________________________________________________________________
The case of TW
In Brisbane, Australia.
TW and L live in a house with another fellow. Their
house is one of half a dozen houses for consumers of
mental health. They are organized by a private
person and are referred to by Integrated Mental
Health in Queensland. I had seen TW and L once a
week for 6 or 8 weeks, two years prior, and have now
recommenced my visits.
On the first of these recent visit L made a comment
that displayed some uncertainty towards the people
within the health care system, which was immediately
followed by TW's reassurance to L that I was on
their side and not on the other side. Over the
several hours I spent with them they both spoke of
their approval and favour towards me. Early
discussion was aimed at finding out if I could
improve the level of enjoyment in their life. I
enquired about the things they might do if they
could and they agreed that they'd enjoy a drunken
party around an outdoor fire but would also like to
go fishing at the beach. They said that they
couldn't go by them selves because they both
experienced a fear of trains and people
(agoraphobia). Ironically, they both loved trains
and wished they could travel on them.
L explained that it was just too confusing. I asked
what happened when he tried, he said he would just
lose the plot and freak out. I asked what he would
need if that happened, he said he would need someone
to help. “How could a person help”, I inquired.
“Just by being there to reassure him and let him
know that it's OK”, was L’s response. We spoke about
their difficulties for some time and we became
familiar with each other once again. I was always
understanding and agreeable. It could be said that
they led the discussion, which they enjoyed very
much. I felt that they were very insistent, and were
successful in gaining my consent on all that they
wished. Through out our discussion I told them how
much I appreciated being there as it helped me to
understand and perhaps help people in their
position. Although I was visiting them for their
benefit as much as my own experience, TW did not
seem to see how I was of any assistance to them and
he said they would be willing to help me any time.
On departure they gave me support and encouragement
hoping that things would improve for me (I was not
working for an organization).
On leaving, I didn't feel comfortable about their
leading the discussion from start to finish. I also
felt a bit bored and had not even attempted to alter
any unusual behaviour. I resolved to turn things
around on my next visit and to be more provocative
with remarks about their behaviours and their
situation, hoping to create awareness, arouse, and
motivate them to be more active. I was also hoping
that this approach would make the visit more fun for
me as well as it being more helpful for them.
On the second week TW and L were waiting on their
chairs outside. On this occasion I wanted to give
them at least as much information as they gave me.
Throughout the visit I repeated that I was
interested in finding out as much as possible about
schizophrenia, as I wished to one day be able to
help people like themselves. While this was true, I
believe that talking about their condition would be
a fairly unobtrusive way to find out about their own
personal experiences.
This lead into some lengthy discussion about how
many schizophrenics, in their opinion, start as
teenagers that reject or leave their parents to
spend more time with peers (and perhaps taking some
drugs). This teenager is then rejected by their
peers for some characteristic that is not “cool”. As
they try harder and harder to be accepted, they are
increasingly ridiculed, and in L’s case, bashed. As
this person becomes more and more anxious, their
desperate efforts to be accepted result in stranger
and stranger behaviour. Eventually, they become so
confused and disoriented that they try to return to
their parents. When the parents are reluctant to
accept the teenager, the teenagers produce the same
desperate and strange behaviour that their friends
ridiculed. The parents reject them, and offer little
or no help. At this stage the teenager “freaks out”,
breaks down, and are then admitted to hospital. TW
said, "It was like being dropped from 6 feet onto
your ass". L suggested that perhaps it was "10
feet", and we all laughed. TW was very forward about
his beliefs of a biological origin and an
un-reversibility of this disorder. TM said that when
things were at their worst, "something clicked", and
then he felt that it had all gone too far and that
things would never be the same again.
TW and L said it was a bit scary talking about those
old memories but were happy to do this for me. They
were unanimous in their approval of me to come to
them as often as I liked, and that they would always
give me an honest account of their lives. I said
that I would never disclose their identities. They
offered to help me with petrol money for visits,
which I declined.
A moment latter I offered to give them an
alternative prognosis that stems from an alternative
theory of the cause. I said that it’s just
information and they may not be interested. They
agreed to listen. I gave a behavioural account of
the disorder and an optimistic prognosis. TW became
emotionally involved, and became quite uneasy as he
insisted that his theory was a “fact” and that no
recovery was possible. The discussion that ensued
demonstrated that TW could only state that an idea
was either fully correct or fully incorrect. He
could not state that an idea may be possible, or
that his position was bases on a theory rather than
a fact. I made some progress in having him accept
that his position was a theory and I continually
reassured him that I understood him and his
position. I showed that I was happy if I could speak
of his explanation as a theory, and the idea that
some people recover (an idea that L was able to
support). Even though a little distance came between
TW and myself from time to time, I was able to show
my desire to understand him which allowed me to
summarise and end the subject on good terms. He was
still shaken and said he'd enjoy a beer and offered
me one as well, which I declined. I then proceeded
to talk about what I did to relax whenever I felt
the need. I thought that TW’s black and white nature
of the world may be worth exploring in my next visit
to see if it was contributing to his difficulties in
the world.
When I arrived at TW and L's house on my third
visit, only TW was there. He is usually sitting in a
chair out the front of his share house whether he is
expecting me or not. He must have heard the sound of
my bike arrive as he made his way to one of the
chairs. At first I was a little disappointed that L
could not be there, as TW, L and myself together
have a good vibe, they both seemed to enjoy my
visits, and I believe they felt safe with each other
there. At first TW was a little more reserved than
usual and I believe that my being with him alone
produced some uneasiness. We asked how each other
had been over the week, without any genuine
responding, so I immediately took the opportunity to
break this pattern of social politeness and be very
genuine. I spoke of my disappointment about my very
poorly organised BBQ over the weekend. It was not
long before he mentioned his extended family and
asked if I'd like to see a photo, and I did. We were
soon talking about his gardening when I mentioned
that he could be paid for that sort of work. At his
disinterest, I guessed that there may be no reason
for him to work and wanted to check by asking what
he would do if he had some extra cash. After his
mention of buying a guitar I inquired about his
playing and we went to the garage, his bedroom, for
a little demonstration. I enjoyed his playing,
especially in comparison to my own attempt. I told
him how much I enjoyed the rhythm of his tune and he
explained that it was his own song and that it was
the sound of a train. I felt that he was sad that he
could no longer enjoy travelling on trains.
Persisting with the idea of getting TW more active,
we returned to the front of the house, and I
suggested that with some gardening work he could buy
a new guitar in a couple of weeks. We talked about
other types of work though every suggestion was met
with ambivalence. I suggested employment agencies,
but he preferred knocking on doors. I enquired about
these doors, he said he could get a job sweeping
floors down the road at a factory, but then said the
medication didn't allow him to be reliable. I found
out it was worst in the mornings which left him the
afternoons. He then said it would soon become too
boring, I said that was a good point and that
another 30+ years in these chairs would be much more
interesting. We laughed. When he said he'd rather
study, we spoke about the options but he said he
didn't know what to study and didn't feel up to it.
I said that's OK, there's nothing wrong with talking
for 10 minutes about something you're not interested
in, we laughed again.
After a while he said he was very happy being where
he was and that if ever he lost his pension he'd go
and find work. When I mentioned how nice it must be
to enjoy his early retirement (now mid 30’s) and
that any work might threaten his lifestyle. He said
that this was pretty much what it's all about. If he
could show that he could work, they might make him
work, and he may not be able to handle it, in fact
he said he really wanted to avoid all that emotional
stuff.
This statement was intriguing, as I had never heard
any one refer to life outside the house as emotional
stuff. When I asked what he meant, he explained that
he didn't like change, he liked things to be the
same, and that anything new was uncomfortable,
emotional, stuff.
While finding that TW was lost for direction or
stuck in a rut may have seemed useful, it was in
fact a behaviour of TW's that occurred during the
discussion, which was most revealing. Throughout our
discussion I was struck by a repeated expression of
ambivalence. It was not the expression which was
unusual, but the times at which he used it. When I
reflected TW's suggestions back, to allow him to
expand, instead of expanding, he made a tone which
expressed ambivalence. To me, it seemed as though he
was ambivalent about his own suggestions.
At this point I thought he may be ambivalent about
his own ideas because they were new. If he had had a
bad experience with one or two new things, then he
may not like anything new because he expected a bad
experience with it. I thought of this because the
previous week when I brought three herbal tea bags,
one for each of us, he declined the offer to try it
and said that he liked his usual tea or coffee, even
though he had never tried herbal tea before.
To check whether TW considered all new things to be
scary, I decided to find out if there were any
things he had never done that he regarded as fun
rather than scary or stressful. To help clarify this
idea I reminded him of his art and asked if he ever
thought about things visually. He was ambivalent
again and he asked what I meant. I said that I often
thought in terms of pictures and that If he didn't
mind I'd like to try drawing a picture to try and
find out if I saw the emotional stuff in the same
way that he did. He fetched a pen and paper, for
which I expressed my thanks. I drew two large
circles, one small circle for the “not emotional”
(familiar) stuff, and one large circle for the
emotional (unfamiliar) stuff. In the “not
emotional/familiar” circle I placed his house, house
mates, and prepared meals, etc. In the large
“emotional/ unfamiliar” circle I placed another two
sub circles; one for the “unfamiliar bad” stuff, and
one for “unfamiliar good” stuff. I then asked him
what he would put in the “unfamiliar bad” emotional
circle and handed the pen and paper to him. He
promptly drew his own two circles within the big
“unfamiliar/ emotional” circle, and instead of
labelling them as “bad” and “good” or “scary” and
“fun”, he labelled them as “achievements so far”,
and “impossible”. In other words, anything that has
not been done already was, not potentially scary or
fun but, impossible. When I asked what goes in the
“impossible”, he mentioned an item, but when I used
reflective listening and asked for him to confirm
that this thing was impossible, again I heard his
ambivalent sighing, and he would not profess the
item to be impossible. To this I said “so why create
a category if nothing belongs in it”, he laughed and
I joined in. We were back where we started,
ambivalent responses when I prompted him to expand
on a point.
I returned to my diagram and asked what goes in the
bad emotional circle. He said that he knew where I
was going with this, but I pointed out that I did
not. I explained that I was just trying to
understand him. With out him offering any items for
my “unfamiliar/ bad” category, I offered some
suggestions such as “work” and “using trains”, to
which he gave his unusual sound of ambivalence. I
could not yet understand why he was ambivalent about
these straight forward questions and, in addition,
he was now developing signs of anxiety. Hoping that
he may now be able to reveal his feelings to me I
said, “you sound unsure....is this difficult”. He
said that this was the sort of stuff that they did
at the Barret Centre (Mental Institution) twenty
years ago, and that he really didn't like it. I
apologised, and said “what exactly is it, you don't
like this whole activity”, he agreed, so I tore off
the page, screwed it up, and threw it away. He
laughed and so did I. He said he was sorry, and that
he just felt really uncomfortable about questions
and answers and all the analytical thinking. I asked
if he minded that I pick up the paper and put
questions, answers, and analytical stuff in the bad
emotional circle for my own record. He said it was
fine and he was sorry again and added that I had
touched on a really sensitive nerve. I said that I
appreciated him telling me so, I didn't want to
upset him, and I was sorry if it reminded him of bad
times, but that I appreciated him telling me what he
didn't like. He said “I just don't know how to
respond, I don't know the correct way, I know there
is a right and wrong way to respond and I really
like to know the correct way. When I don't know how
to respond I start to panic, and that’s when I go
weird and freak people out”. TW may have been so
unfamiliar with someone wanting him to expand on
what he had said, through reflective listening, that
he thought I was looking for a correct answer,
testing him, or being critical, and so his
ambivalent sigh and anxiety become understandable.
It seemed that believing that there was a correct
response and not knowing what to do, was expected to
result in the loss of contact with whoever he was
with. I asked if that was what happened when he was
rejected from his peers, he said it was and that “I
guess that's why you always need to know what the
cool behaviour is or you get dropped on your ass”.
I asked whether not knowing how to respond is what
made all the knew stuff (including new questions) so
emotional and uncomfortable, he said “I guess that's
it James, I just don't know how to behave”. He went
on to apologise for being so uncomfortable a moment
ago and said “I hope you don't leave here and think
to yourself, gee TW is pretty weird, and then not
come back”. I told him “I didn't come here to see
correct behaviour, I came here to see TW and L”. I
reached across and we clasped each other's right
hand. He said “that’s really cool James, you’re
really good with people James, you've got a really
good bedside manner”. I said, “you can't imagine how
much weird stuff goes on out there” and gave a bunch
of examples to help him see that there is not
necessarily a correct way to behave, and that
“uncool” behaviour is common.
On my forth visit, there was only TW again. TW was
pleased to see me. He immediately said he had bought
a box of green tea and that he preferred it to
coffee or tea, and felt better for drinking it. TW
also said that he had reduced his alcohol intake
from about a dozen beers a week to about half a
dozen beers a week. We shared our past week with
each other and simply enjoyed each other's company.
Towards the end of my visit I mentioned that I'd
like to send a summary of our most important
interactions to Jack Rosberg for inclusion on his
web page because Jack and I believed that our (TM
and myself) time together was the sort of
interaction that may be good for people in his
situation to give them a greater desire to be more
active or feel better about the things they're
already doing. This is when TW explained to me how
he felt.
TW said that things were starting to change lately
and that he didn't know what had lead to the
changes. He said he had been able to buy the tea
bags at the shops, as well as other activities, with
greater ease. He said that perhaps it was because of
our time together. It was of particular significance
that he was able to talk about things that he has
never been able to talk to anyone about. TW said
something like the following.
“You know James, something happened last week. It
was when we were in the middle of our discussion and
you were drawing those pictures. We got to a point,
we shook hands, and then something just clicked.
Since then I haven't been feeling so self-conscious.
It's not about words or something I think about,
It's just the way I feel. I feel different. I think
something has happened. I've seen shows on TV where
a Doctor can just talk to someone and just turn
their lives around, but I never thought it would
happen to me.”
Before I left for the day I asked him if he had done
something this week that scared him. I wanted TW to
expose himself to new situations and feel
comfortable with whatever behaviour he produced. He
mentioned going to the shops to buy his green tea
and some other things and I responded positively
(without being condescending). Then I mentioned that
many people believe it's important to do something
that scares us every day. TW agreed and was positive
in his reflection of the difficult things that he
had done.
In short, while TW did not want me to have high
expectations of him, he felt that something inside
him self had been reversed. He no longer thinks of
himself as a lost cause, he believes that progress
is possible, and he looks forward to the challenges
of life. TW and I both realise that he has been out
of society for a long time and so has some catching
up to do in the social skills department, but we
both feel that he has turned an important corner.
During my fifth visit TW told me that he had
recorded some of his guitar playing and sent the
cassette to his cousin. While I was with him, he
spent less time sitting down and came into the
kitchen with me (first time) to make tea. He was
more willing to get involved. While we were talking
about transport, TM asked a lot of questions about
my motorcycle and accepted an invitation to sit on
it and start it up. It was the first time he had
ever done so in his life. Shortly afterwards he
confessed that it wasn’t as scary as he thought it
would be. Next week he has agreed to go shopping
with me to find some new cloths (without holes). A
life begins.
(I would like to mention that the ideas for future
therapy in TW's letter resulted from unrestricted
brain storming with TW, L, and myself, which was
terrific fun. As brain storming produces a wide
range of responses, I have not included one of TW's
suggestions as I do not believe it was appropriate
for this web page.)
A Letter for James
Both L and I think that James is a really good bloke
and really enjoy his company. Mostly we like his
down to earth attitude and find that he is really
easy to talk to.
I usually have a lot of trouble communicating with
other people and can honestly say that I feel a lot
better and have really sorted out some issues.
Talking about problem issues has never really worked
for me. But now I realise that it can really help. I
think that half the battle is finding someone that
you can connect with.
I must admit though that medication to me is
paramount and being open and honest is really the
foundation of all we’ve been getting through. I can
honestly say that there has been a positive change
in me. It’s hard to put a finger on, but I feel a
real sense of natural calm, and can only put it down
to the kind of therapy I’m getting from James.
We talk through issues and come to the real
solution, finalise the problem, shake hands, and
move on. I don’t really know what’s in the news
letter James has written, but some of the Ideas
we’ve discussed are really great ideas and would
really work.
Early positive therapy that is to help pre mental
illness, to watch for symptoms and act upon them. To
get positive information out to the community, with
back up response teams. That is prevention rather
than cure. Alternative therapy. That is to use
friends as a support group. To make the subject feel
safe, loved, and secure. To use exercise, to
motivate social skills. And at all times to just be
the best friend you can be. These are just some of
the things we’ve touched on.
I saw somewhere that schizophrenia may have a cure
soon. But it’s the emotional scars that are left
behind that will probably always be there, and if
you can cure these, simply by talking and being a
friend, what a difference that would make.
I’m not saying that I’m cured or don’t have my usual
problems. But I really do feel better and I guess
it’s just nice to have someone to talk to.
All I can say to the sufferers of mental illness out
there is to find a friend and talk, but try not to
hold too much back, try to be open and honest, try
to trust a little bit, and know that you’re
important just like every one else. I realise now
that you can talk about things till you’re blue in
the face, the trick is having someone to talk to
that knows exactly what you’re talking about, and
knows what you need to know and can tell you. It’s
like a big puzzle that you both played with as
children, you both know the puzzle but now you need
some help putting it back together. The trick is,
knowing exactly what you’re saying on the same level
in a language you can both understand. James has
shown me that you don’t have to be superman and it’s
enough to just have [been] helped a little bit, a
little bit is still a hell of a lot and any measure
of change is great, especially if it’s positive.
Anyway, I’ll keep on battling on and I’ll keep
listening and sharing.
Yours faithfully
Mr T.W.
p.s. Brick by brick.
(This letter was written after four 3 hour
sessions.)
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