Three service users and three service providers were invited to give feedback on PERFECT's research on the potential benefits of false or irrational beliefs. This happened via a game. They were presented with some statements and asked to locate them on a poster, where some areas indicated strong or moderate agreement, some strong or moderate disagreement, and other area no particular opinion. They were then asked to explain their choices.
Some notes follow on the parthcipants' views and discussion.
Some mental health difficulties may have positive outcomes. EVERYONE AGREED
Reasons for this choice included: Some mental health difficulties allow dialogue to happen, and are part of a larger scale change. They provide a context for re-evaluating life circumstances: the period of recovery can be understood as a period of discovery where people find a way of relating to the world. With self-harm, people who get better realise that the anxiety they experienced makes them stronger (growth). Also, self-awareness can be a positive outcome. People work through their beliefs to understand why they are important to them, and new knowledge about oneself is acquired.
Mental health problems are primarily a matter of human suffering. MIXED REACTIONS
Reasons for this included the thought that ‘suffering’ is an unhelpful word. Thinking in terms of suffering implies that the person can’t cope, can’t do anything about what is happening to her. Maybe ‘distress’ is a better word as it does not have the same connotation of passivity. Some participants also asked what the statement means. That mental health is an existential struggle? Or that human suffering causes mental health problems? Mental health problems are not always a matter of distress. And thinking that they are may be excessively individualistic.
Delusions may help us understand what is going on in a person’s life.
Reasons for this included the idea that delusions are not always un-understandable but can reflect individual and social issues. Some participants talked about their clinical experience and their research to support their views. In clinical experience, often delusions are related to a person’s life experiences (such as bullying). The content of delusions is helpful to understand people. Sometimes delusions have value, contrary to society’s norms. At times they are helpful and at other times they are not. They can give us clues about what the person is feeling and why she is struggling. Many people do not want their delusions to be regarded as symptoms to be eradicated. Delusions can also be protective mechanisms.
Unusual beliefs are often clinical symptoms of severe mental illness. UNANIMOUS STRONG DISAGREEMENT
Reasons for this included the thought that many unusual beliefs are present in the general population and do not indicate mental illness. Moreover, what is considered to be unusual changes all the time. For instance, homosexuality was being treated as a mental illness in the seventies.
It should be the role of a clinician to help service users change their unusual beliefs.
UNANIMOUS STRONG DISAGREEMENT
Reasons for this included the idea that we should not think of changing people's ideas as a duty of the clinician. One suggestion was that 'challenging beliefs' is better than 'changing beliefs' but neither should be done independent of the context. Moreover, the fact that a belief is unusual is not a good reason to want to change it. Perhaps it is better to think about changing or challenging distressing beliefs as opposed to unusual ones.
Service providers should help people notice and acknowledge the positive sides of their experience.
Reasons for this included some concerns about the word 'should' and the assumption that there is always something positive in the experiences that attract the attention of mental health practitioners. If there’s something positive in the experience, then it seems plausible that service users should acknowledge it. But not always there is a positive side.
The content of delusions is related to one’s life experiences.
Reasons for this included the idea that, although delusions can be related to one's life experiences, they do not need to be. People have unique and individual experiences. What connections we can draw depends on the person’s history. Sometimes there are relations between the content of delusions and life stories, but they are difficult to find or the person looking for them is not skilled enough.
After the game, participants discussed the work of PERFECT and the involvement of people with life experience of mental distress in research, including philosophical research. Some attention was paid to the best methods to use to elicit feedback.
For the PERFECT team and for the participants (we hope) this was a very useful exercise and a source of inspiration. If you do have reactions to the statements above, please let us know in the comments! We would greatly value our blog readers' views on these issues.