Brief Interventions for Psychosis: Overview and Future Directions

Psychosis (etymology: Gk. psyche + osis, condition) as defined in the Merriam-Webster dictionary (http://www.merriam-webster.com/dictionary/psychosis) is a mental and behavioral disorder due to fundamental derangement of the mind (as in schizophrenia) and is characterized by defective or lost contact with reality especially as evidenced by delusions, hallucinations, and disorganized speech and behavior. This causes gross distortion or disorganization of a person’s mental capacity, affective response, and capacity to recognize reality, communicate, and relate to others to the degree of interfering with that person’s capacity to cope with the ordinary demands of everyday life. The word psychosis has become a part of the vocabulary of general population including the media and is extremely stigmatizing. For many in general public, psychosis is synonymous with schizophrenia and is associated with dangerousness and negative stereotypy, often leading to social distancing, discrimination, and even victimization (Diefenbach 1996; Wood et al. 2014). Societal stigma combined with self-stigma leads to diminished opportunities, demoralization, and impaired recovery process for individuals with schizophrenia and other psychotic illnesses (Corrigan and Wassel 2008; Horsfall et al. 2010). Also, mental health practice until very recently was guided by the belief that individuals with serious mental illnesses like psychosis do not recover. The course of their illness was either seen pessimistically, as deteriorative, or optimistically, as a maintenance course (Harding and Zahniser 1994). The pessimistic outlook goes hand in hand with biomedical conceptualization of psychosis that neglects environmental risk factors (Mizrahi 2015). While the biomedical hypothesis is a driver of pharmacological research and current practice, meta-analyses of first person accounts of mental illness show that there are a variety of opinions about the cause of psychosis. Different individuals view the cause of their condition as spiritual crisis, environmental cause, and political, biological, or specific trauma (Farkas 2007). Psychosis can be attributed to one or other medical illnesses (most importantly neurologic or endocrine), and determination of a cause-effect relationship between a medical illness and psychosis is not always easy. Importantly, the disconnect between the opinion of professionals and individuals extends to the focus of treatment. While professionals have been focused on symptom remission and reduction in hospitalization, people with psychosis are more focused on regaining life roles and improvement in quality of their life. In fact, a recent report of the state of mental health systems in the USA has concluded that mental health care in America fails a wide variety of individuals but particularly fails those with serious mental illnesses (IOM 2006) because it is “not oriented to the single most important goal of the people it serves, that of recovery” (The President’s New Freedom Commission on Mental Health 2003). An objective look at the outcomes for psychosis shows that contrary to prevailing professional opinion, there is evidence from several studies that a sizable proportion of individuals with psychotic disorders have good outcomes. For example, in a 15–25-year follow-up of individuals with psychotic disorders in 18 different countries, it has been revealed that the majority (56 %) showed recovery. A sixth of them were completely recovered to the point of not requiring any treatment (Harrison et al. 2001). In addition, people with serious mental illnesses have themselves published accounts of their own recovery as well as advocated for the development of recovery promoting services (Farkas 2007). All the above point to an urgent need for us in the profession of behavioral health to rethink how we conceptualize, label, and treat psychotic disorders. We need to look at our existing services, how they are delivered, and their focus to make them align with the goals of individuals who are suffering with these disorders, their families and communities supporting them.