Evidence suggests that psychosis, in at least some cases, has a similar disease course to other chronic illnesses. Cancer, for example, progresses along a continuum, and we know that if we intervene early we can create optimal outcomes for a cancer diagnosis. More and more we’re seeing this understanding translate into care for psychosis as well. In this podcast interview with the Hogg Foundation, Dr. Neely Myers argues for a more nuanced, but ultimately more hopeful, understanding of psychosis and she urges the entire community to take up the charge for early intervention.
In another similarity to cancer, research suggests that psychosis is not “random.” There can be genetic markers as well as environmental factors or adverse childhood events that may predispose an individual to psychosis. Although there are no direct causal pathways in genetics, these individuals may have a genetic vulnerability to react to stress in a certain kind of way.
In 2016, Dr. Neely Myers and the Hogg Foundation’s Dr. Octavio Martinez co-authored a piece entitled, We Are Failing Young Adults With Psychosis, which discusses the ways the mental health system fails to address fundamental needs of young adults, and instead perpetuates the problem.
Young Adults and Early Intervention
One quarter of adults experience mental illness. When they seek out help, sometimes they receive the wrong kind, or they receive the wrong message, or they don’t receive any response and support at all. However, early intervention can help prevent psychotic episodes or ensure optimal outcomes, especially in young adults.
Dr. Myers, an Assistant Professor of Anthropology at Southern Methodist University, suggests that young adults are a particularly fertile population for intervention since they’re usually at the beginning of their experience of mental health issues. They’re also usually still employed or in school, and still connected with their families. Meaning, there’s often the integral support needed for a higher chance of recovery, before they start to “fall through the cracks.”
Reframing the Issue of Psychosis
While there’s no one answer, Dr. Myers suggests that young adults who present with psychosis—as well as their loved ones—often feel frightening and alienated. There is increased need for non-coercive approaches with this consumer population as young people are more likely to follow up with care if they’ve had a positive experience on the front end.
Instead, psychotic episodes often lead to emergency care or police intervention. Dr. Myers highlights diversion programs—where an individual is picked up by peers—and peer support as ways to give young adults the comfort and connection they need.
Prevention is an important piece of the equation when it comes to psychosis and psychotic episodes. Dr. Myers says that early intervention can prevent neurally-damaging processes that may happen for people after they’ve received a diagnosis. The fallout can include social isolation (losing a job, being stigmatized, etc.), the potentially toxic side effects from long-term anti-psychotic use, self-medicating for relief which can complicate outcomes, and even the depression and anxiety that is common with the stress of a diagnosis.
Dr. Myers says, “We’re trying to stop these negative downstream consequences of poor care up front, with strong and appropriate early intervention.”
Dr. Myers discusses the need to work with educators, families, and religious leaders to recognize when a young person is approaching the territory of psychosis. Then with direct family involvement, by supporting the individual to stay in school or employed, by offering them individual therapy, and possibly with low dose medication, we can make strides toward preventing a possibly damaging crisis.
Mental Health and the Media
Mental health issues have become a part of mainstream media coverage. Additionally, we’re seeing mental health diagnoses on the rise in young people. The positive is that young people are sharing their personal stories, and that can be comforting for people who are trying to learn about the illness or who have recently been diagnosed. However, Dr. Myers points out that the challenge, especially in public policy, is to keep the conversation from becoming “over radicalized,” in her words. She says we must be careful to balance medical intervention with social and environmental ways to help prevent or address concerns.
“We need to challenge the ideas of mental illness that lead to isolation and stigma. It’s a conversation we can have in the community in a way that promotes recovery,” says Dr. Myers.
Lastly, Dr. Myers discusses her book, Recovery’s Edge: An Ethnography of Mental Health Care and Moral Agency, which she wrote after spending some time in a rural agency and taking part in a peer-run experimental program. In her book, Dr. Myers mades a conscious effort to try living the life that people with mental health conditions were living. The result is a compassionate perspective through the eyes of people using mental health services.
Voices of Recovery: Becoming Doctor Deegan
Following the interview with Dr. Myers, we hear a clip from our video, “Becoming Doctor Deegan,” where Patricia Deegan talks about her experiences being diagnosed with schizophrenia. She describes how she turned around her perspective after being told that she needed to “retire from living” at the age of 17, and being put on medications that, for her, were as disabling as the disorder itself. In 2014, Dr. Deegan delivered the keynote address at the Hogg Foundation’s biannual Robert Lee Sutherland Seminar. Her address was titled, “Personal Medicine, Power Statements, and Other Disruptive Innovations.”