ISPSUK AGM

why relationships matter

On Friday I ventured down to London to attend the ISPSUK annual general meeting. I was drawn there by the theme of the day:

Psychosis: Why Relationships Matter

I wasn't disappointed: the talks were excellent.

• “How Diagnoses Keep People Apart” (Prof. John Read)
• “First Do No Harm – Iatrogenic Harm in Mental Health” (Dr Jacqui Dillon)
• “Intentional Peer Support – A relational approach to experiences that might get labelled as ‘psychosis’ ” (Lisa Archibald)

I was delighted to hear Lisa speak. Only last week I had visited Lisa in her hometown of Galashiels in the Scottish Borders. We have mutual acquaintances through the MSc Mad Studies course, and I'd heard great things about her and wanted to meet her in person. I had also wanted for a long time to visit the Great Scottish Tapestry in its purpose-built visitors centre in Galashiels, so I had made a day of it. Now, fresh on the heels of that visit, I listened with interest as she joined the panel of speakers.

All three presentations spoke with compassion about the turmoil and disruption that a psychotic spell can have on the lives of the individual and those around them. And all three spoke to the isolation, judgment and fear that one encounters from others on the back of an experience of psychosis - not simply during the psychosis itself but also later, when one is labelled with a psychiatric diagnosis.

It was highlighted poignantly how much a negative, fearful and judgmental response impacts upon a person's wellbeing, and creates a feedback loop whereby they act negatively, fearfully and defensively (all of which is then interpreted as symptoms.) We were asked to consider: what happens when we pause and reflect upon the contexts in which a person operates? Rather than locating the psychosis within the individual as their own discrete problem, what if this is actually a relational phenomenon?

We don't live in a vacuum. Every person who experiences psychosis brings with them a web of personal history and a complex interplay of relationships.What if we responded to psychosis with an inquiry something along the lines of 'Who are you? What is happening for you? What are the experiences you bring with you? How are you making sense of them right now? What do you need, and how can I help you?' The Power Threat Meaning Framework phrases it like this: instead of asking 'what's wrong with you?', try asking 'what has happened to you?'

Finally, it was pointed out that the professional relationship is still just that: a relationship. So as soon as one introduces the tremendous power imbalance between the psychiatrist on a ward and the patient in their care, one establishes a distorted relationship which becomes itself a context to be navigated.

I'll wind up this post here, but I expect to come back to further reflections on this event, as the three talks and the subsequent discussion gave me ample food for thought. I've only skimmed a partial surface of what was presented and explored on the day.

Speakers and Chair: Lisa Archibald, Jacqui Dillon, John Read, Simon Downer