Coaching for Mental Health: Ethical Dilemma or Ethical Development?

Appendix 8: Psychosis and creativity

Lawyers know that the term psychosis has been used as a ‘catch all diagnosis’ if they neither understand, nor are able to treat a mental health condition. Current trend is to use diagnosis of borderline personality disorder, when the “client does not fit in a specific box or society” (mental health worker)

Raj Persaud observes, “a psychiatric symptom should only generate concern if it prevents individuals from conducting their lives as they would like, or leads to the suffering of others… Indeed, there is a shift in view among some psychologists that the key issue is not the symptom itself, but your ability to retain control over it”. Staying Sane (p.96)

“Strong Imagination” by Daniel Nettles blends “madness, creativity and human nature” to examine this human ability of creative interpretation for mental health. Use of cognitive language to explore abstract ideas is the basis of intelligence. Psychotic behaviour and language acts out abstract awareness, adding colour and dimension to intellect. This personal language is a unique interpretation of our reality, not evidence of abnormality.

A report from the Mental Health Foundation on spirituality highlights the “potentially narrow line between hallucination and vision, which could lead to people either being seen as “psychotic” or “spiritual” depending on the interpretation of their experiences
”…but also stressed that there should be more attention paid to developing a wider spiritual or religious knowledge in other staff, including training psychiatric nurses and support workers.
Spiritual or religious beliefs are important to many people, particularly at times of crisis,” said Vicky Nicholls, Strategies for Living project co-ordinator, Mental Health Foundation. “Mental health services should learn to explore people’s needs and enable them to seek appropriate support, rather than either seeing religious or spiritual beliefs and experiences as a symptom of illness or simply ignoring them.” (26.4.2002.

Unfortunately most psychotic behaviour as seen in mental health is the result of an individual attempting to come to terms with unacceptable life experiences, “People who have psychotic experiences very commonly report having had highly distressing or traumatic life experiences such as bereavement, abuse and assault. The common themes appear to be extreme threat, abuse or events that lead to overwhelming emotions.” Clinical Psychology Report. 2000 (p.32). People who may never have experienced any opportunities for learning self-definition and no obvious control in their lives. Their bizarre behaviour may be out of context with their external environment but is a creative, intelligent response to their actual or internal experiences.

A case study highlights this of a patient trying to self manage using a delusion of being a grand military figure in order to cope with his fear and terror, the therapist asked, “‘Is this an ashtray?’ to see if I knew or not. It was as if you knew and wanted to see if I knew… that only made me more frightened, more panicked. If you had been able to understand how crazy I had to be so that I could be strong enough to deal with this life threatening fear then we could have handled that crazy general”. Clinical Psychology Report. 2000 (p.32).

This rather suggests the need for life skills and personal development instead of diagnosing and pathologising an individual by their behaviour. As we have seen, extreme emotions make us stupid not mad/ insane /pathetic, just temporarily stupid. In fact I would like to propose that some of the coping strategies used, though apparently bizarre, are in fact a sign of mental health rather than illness, self management in order to cope with unacceptable conditions.

Research from the Institute of Psychiatry “has shown that about 4% of the general population hear voices and that voices can be seen on a brain scanner as emanating from that part of the brain that normally produces verbal thoughts or ‘inner speech’”. Robin Murray Guardian Society 16.01.2002 p.7

Internal dialogue is a normal coping strategy used by fully functioning people, hearing voices is an exaggeration that can develop into aberrant behaviour if not addressed appropriately. “It now seems to me that the voices always feed off negative images I have of myself. I can think about the voices being a by product of my own self image” this awareness came as a result of support from a therapist who initiated “The collaborative relationship I have with Paul gives me confidence that my ideas, as well as his are important, I get to say what I want to work on — I have some power in this relationship, Paul gives me feedback and some idea of his reaction and tells me what area he might like us to cover. He does this whilst giving me a lot of power and I feel that I am in control”. Report. (p.46).

Sounds like a typical coaching alliance relationship to me. Focussing on the coachee in the full context of their life. Using relaxation and visioning techniques and the creative language of image and metaphor the coachee builds up a new inspired picture of their self and their future. In other words the individual finds their own voice and sets their own context within a complex and challenging world.


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