A MODEL TO MAKE SENSE OF PSYCHOSIS
We took a deep dive into the underlying design principles of our psychosis simulation tools and unlocked five key themes to understand psychosis. We placed these themes on a map: The Anoiksis Map.
ARE YOU READY?
Imagine a world in which psychosis is viewed as a deeply transformative journey. Imagine a world where early recognition and understanding of psychosis is normal. Imagine that when we enter a state of psychosis for the first time that we are not surprised and have a sense of what to expect and what to look for. Imagine that coordinated specialized care is routine, accessible, and affordable. Imagine that family members and friends all understand and support us. Imagine that neighbors, employers, politicians, and the broader society understands and provides resources that are helpful in this time of transformation.
BROKEN HEARTS AND EMPTY WALLETS
Sadly, this world remains mostly in our imagination. The current way of managing psychosis is costing billions in healthcare each year, it is emotionally disconnecting, and is a way that is limiting healthcare professionals in their ability to help with a transformative recovery. We do not talk about it, we do not know how to recognize it, or what to do when we encounter it. We don’t recognize what is happening or respond until there is a crisis. There is a disconnection between care providers, so much so, that we avoid the mental healthcare system when we are in crisis. Family members are disconnected and scared, and the broader society is avoidant, fearful, and dismissive. Quality care and support are not easily accessible and incredibly expensive.
RE-FRAMING THE STORY OF PSYCHOSIS
The lens from which we view psychosis shapes how we manage it: as individuals, as families, as mental healthcare professionals, and as a society. The lens is fragmented, incomplete, and, as such, harmful in many ways.
The current lens from which we view psychosis tends to focus on diagnosing symptoms, categorizing behaviors, and labeling. Labels give a name to experience but do not help us understand the experience. One does not understand an iceberg by looking at its tip. Without a deeper understanding, labels will continue to perpetuate stereotypes and stigma. The story of psychosis is broken, we need a different story. For this we expanded the concept of Anoiksis:
WHAT IS ANOIKSIS?
Anoiksis is an ancient Greek word meaning ‘Open Mind’. Anoiksis is the name of the Dutch association run by and for those of us who deal with psychotic states. Anoiksis is important because it moves beyond a diagnosis, challenging us to look at what it may feel like to be in Anoiksis. We are working towards a new premise for psychosis that is inspired by Anoiksis. In which we take data from lived experiences as crucial.
In this, we view Anoiksis as a survival mechanism in reaction to high-impact life events (positive and negative). Where we go when change is needed, be it emotional change, mental change, spiritual change, emotional change, or physical change. We view Anoiksis as an altered state of consciousness, much like fever or delirium, in which sense-perceptions and forms of thought change drastically in order to disrupt. Be it in reaction to an infection, inflammation, spiritual emergency, mental or emotional patterns, and provide new possibilities.
By activating one's imagination in this state, people are able to generate life-altering insights and have the potential for positive personal, relational, and more broad systemic transformation. In this state, the brain is an ally, not an enemy. However, if we don’t have the right navigation tools in Anoiksis, we can get stuck and suffer. We call this (Deep) Anoiksis.
The goal is to create intimate knowledge of our body/mind/spirit/heart - our system as a whole. The phenomenon of Anoiksis includes experiences labeled as psychosis, but goes beyond it, capturing mental health on a shared spectrum. We All know Anoiksis. But how to explore (Deep) Anoiksis? How to recognize if we are getting close to the edge? How to use the map?
A SUMMARY OF THE ANOIKSIS MAP
AND HOW TO USE IT
THE ANOIKSIS MAP consists of five exploration themes or 'Five Pillars of Consideration'. By identifying these themes and how they are related, we can recognize and shift the system. When we learn to navigate the map, the state of Anoiksis provides clues for deeper, fundamental needs. By identifying and serving those needs, it’s possible to move through this disruptive and transformative state. There is no set process or a specific order in which to explore these themes. Depending on the situation, it may be more relevant to first look at: ‘what is needed’ or ‘what has happened?’
WHAT IS EXPERIENCED?
The key: Identify how senses and perceptions are altered in an experience of Anoiksis.
In (Deep) Anoiksis our sense-perceptions alter more extremely - they can become hypersensitive or hypo sensitive.
EXAMPLE: Early recognition may be in experiences of colors changing. They may become more vivid or they may seem dull and off. Background noises may come to the foreground. We may experience time running faster or slower. We may become thin-skinned. Emotions or words may hit us very hard.
TIP: Think of it as suddenly being sensitive to sunlight. The light of the sun has not changed, the sensitivity to the light has changed.
WHAT MEANING IS MADE?
The key: Discover the link between sensory experience and the story created and distinguish metaphorical significance from literal sense-making.
We rely so heavily on our senses that it does not occur to us to question them. Instead, we create stories, even if that story seems unusual because it supports our experience. In this stage, we can learn to distinguish metaphorical significance from what may feel like a literal truth.
EXAMPLE: Prevention can be found in understanding the play between the senses and the metaphorical and literal (underlying) meaning that is created. See a literal thought that “someone is poisoning me” as potentially born from a heightened sense of taste. Investigate personal significance: feeling unsafe? Alone or abandoned? Recognize the underlying need and act on it
TIP: Think of it as ‘WAKING DREAMING’ in which all associations can be experienced as literal or metaphorical realities.
WHAT DISRUPTION HAPPENED?
The key: identify high impact life events and discover links between these events, sensory experiences, and meaning created.
In a model of Anoiksis, we enter the altered sense state of waking-dreaming in reaction to a disruption in our spiritual/mental/physical/emotional stories. A series of high-impact life events may instigate such a disruption.
EXAMPLE: Being in love. Deep loneliness. Significant loss or death. Not fitting in. A broken heart, love-sickness, a messy divorce. Moving away from loved ones, forced migration, moving to a strange city, or a trip abroad.
TIP: Positive high-impact life events can be just as impactful
The key: identify how certain internal and external bio-psycho-social triggers influence altered sense-perception and meaning-making. Discover links between triggers and high-impact events.
In an Anoiksis Model, there are several major risk factors that (speculatively) influence the evolution of high-impact life events.
EXAMPLE: Sleep disruption, chronic stress, hormonal disruptions (puberty, menopause, pregnancy) nutritional disruption (vitamin deficiency), intergenerational trauma, fetus development, medicine, recreational drugs, poor nutrition, vitamin deficiency.
TIP: Think of Anoiksis as a system, imagine a knot of string. Pull-on one loop and all the others may follow…they are interconnected and often feedback on each other. Focus on the system, on the phenomena, and how they relate. Don't focus solely on symptoms.
The Key: Identify the deeper, core needs by piecing together information from all five themes. Create ways to practically serve those needs.
Deeply ingrained in the stories of our minds, bodies, and spirits lay our cultural metaphorical and literal influences in relation to our needs. The clues we have gathered from the previous themes - how our senses change, the stories we create, what disruption events happened, and our triggers - can help us discover what we need.
EXAMPLE: Needs can be basic such as financial security, healthy nutrition, safe shelter, or loving connections. When we are followed by the FBI, we may hold a need to feel safe. How to help a person feel safe? Needs are diverse. Some need to suppress experiences. Some need to make art. It is the job of ourselves, and our carers to listen to those needs and act.
TIP: Engage in authentic Deep Listening. Under a symbolic need is a need, is a need. Ask the same question 5 x and you will get a different answer.
WHY THE ANOIKSIS MAP?
UNDERSTANDING PSYCHOSIS IS HARD
We know that understanding what it is like to experience psychotic phenomena is difficult. Those of us who have experience with it find it hard to describe, and those of us who do not have that experience find it hard to envision. We know the pain and struggle of this confusion. After all, We are family members, mental healthcare practitioners, and people with our own lived experience of psychosis.
CRACKING THE CODE OF PSYCHOSIS
We have dedicated the last 14 years to researching, developing, building, and helping people learn about what it is like to be in psychosis. We worked with over 60+ stakeholders, among many with experiences of psychosis, to capture the breadth and richness of this phenomena and place it into a model that helps us to make sense.
THE ANOIKSIS MAP VALUE
A comprehensive framework to navigate the complexity of psychosis for empathy early recognition and prevention. THE ANOIKSIS MAP helps with the following:
• Brings clarity - The Anoiksis Map appreciates the diversity of subjective experience but identifies patterns and structures that bring an overall framework to a variety of subjective stories. The map holds space for a range of subjective experiences, both glorious and terrifying, both exaggerated and subdued.
• Helps with early recognition & prevention - This map helps us to recognize early signs ahead of time and process these experiences before they escalate. When psychosis is recognized on time it can be dimmed, subdued, or even prevented (if desired). But also better navigated and channeled.
• Improves care & understanding - This map provides a frame to understand the subjective experiences of psychosis. This map helps us distinguish subjective reality from literal truth - when we can look at someone’s subjective experiences from a distance, we have the potential to learn more.
• Builds empathy skills - This map puts psychosis on a spectrum of experience and creates bridges between psychosis and other human experiences.
• Improves treatment strategies - We can help discover the significant metaphorical meaning coming through the experience - if the experience is arising for a reason, we may even benefit from why it arises in the first place. We can connect subjective sensory experiences to wisdom about oneself, his/her relationships, and the broader world.
THE ANOIKSIS MAP shows the experience as a reaction to a wide range of mental, physical, and or spiritual high-impact life events. By taking a holistic frame to this experience, we can begin to take a collective and systemic approach to recovery.
BREAKING OUTDATED MYTHS ABOUT PSYCHOSIS
When we can’t understand it's harder to connect. When we don’t connect, we’re left to our own assumptions, fears, and outdated myths. Like these:
MYTH: Psychosis as only a destructive phenomenon, one that should be avoided at all costs, as deteriorating the brain each time someone enters into this state.
TO: Psychosis is not to be feared, it is the coolest thing our brain does to protect us. Our brain is not our enemy, it is our biggest ally, but if we don't listen, we will suffer.
MYTH: Psychosis as a disorder of symptoms, with no meaning or value - a misfiring of neurons, a chemical imbalance. Any thought, idea, sense, experience in this state is seen as nonsense and ignored.
TO: Psychosis is a collection of phenomena, full of meaning and valuable information about our needs, and how to address those needs. Needs can be physical, mental, emotional, spiritual.
MYTH: Psychosis as a binary state - there is no spectrum with which it exists, making it incredibly hard to identify early sensory experiences.
TO: Psychosis as a spectrum state - recognizing a descent into psychosis is not only possible, it can be a choice.
MYTH: Psychosis as a biomedical disorder - treatment primarily consists of medicine and research/treatment methods are narrowly focused on this area.
TO: Psychosis as a transformative system collapse - Support is system focussed, Deep Listening to underlying needs, and addressing multiple areas at the same time. Sleep patterns, nutrition, thought patterns, inflammation, etc.
MYTH: Psychosis as solely a problem of the client - discounts the value of context (life experience, relationships) on the experience.
TO: Psychosis as a social systems problem - taking into account the value of context to an individual, as well as a social system
The lack of understanding results in a lack of action with missed windows for prevention and early detection, unnecessary emotional suffering, physical and emotional escalation.
Be kind. Keep learning. Be mindful. Be forgiving. Respect boundaries. Keep trying