WHY PSYCHOSIS IS NOT SO CRAZY

How new thinking about psychosis can chart a positive way forward.

In a book first published in Belgium in 2021, Vanheule, a professor of psychoanalysis and clinical psychology, combines a long history of treatment of patients suffering from psychosis with a firm grasp of the current research on the subject. About 15% of the population will have a psychotic experience at some time, notes the author, although only a small proportion will progress into a condition of full-blown psychosis. Psychosis involves a loss of contact with reality, which usually starts in late adolescence and involves hallucinations, hearing voices, and feelings of paranoia or grandiosity. Vanheule discusses the case of a patient who engaged in complex, argumentative conversations with an imaginary companion; another was convinced that inanimate objects were speaking to him. The author investigates the way that psychotic patients use language, which can sometimes reveal the trauma or issue that triggered the psychological break. Antipsychotic drugs can help in some circumstances, but the most valuable tool is a therapist willing to take the time to build an empathetic relationship. Some psychotics show a strong creative streak, which should be encouraged as a means of expression. The therapeutic goal is to provide a sense of connectedness that can guide the sufferer back to reality. Vanheule believes that most psychotics are deeply confused, caught between clashing images of the world. Sometimes the best option is to keep the condition within manageable limits rather than search for a complete cure. The author has had considerable success with his treatment ideas, but he emphasizes that “there are no miracle remedies for treating psychosis.” Still, he provides useful information for sufferers and those who care for them, laid out in an articulate, sympathetic manner.

With decades of experience, Vanheule explores the roots of psychosis, building a framework for understanding and treatment.