Dr. Jan Wallcraft

Some existing and emerging theoretical frameworks

Psychosocial model Crisis model Trauma model Psychospiritual model

Self-advocacy/empowerment model Experts by experience Self-management or coping frameworks Service user run services and research Strengths approach Recovery model

Crisis modelCaplan set out a model for primary

prevention of mental disorder through recognition of and support for the needs of people in ‘developmental or accidental crises’. He defined a ‘crisis’ as a short, intense period of psychological disequilibrium.

Caplan investigated the ‘cognitive and affective upset’ resulting from transitions between phases of life (developmental crises) and particularly those precipitated by unexpected accidents or life shocks (accidental crises).

Crisis modelCaplan outlined a basic theory of human

needs, hypothesising that healthy personality development requires continual supplies of physical, psychosocial and socio-cultural necessities commensurate with the person’s level of growth and development.

Psychosocial needs, he suggested, include the need for continuing relationships with significant others, the exchange of love and affection, the need for limitation and control, and participation in joint activity.

Crisis modelSocio-cultural needs as described by Caplan

include the need for social customs, norms and values, which provide stability and influence personality development.

These provide the individual with a sense of external security, a place in the social structure, a path in life, a social role and rewards.

He argues that the lack of psychosocial or socio-cultural supplies, or alternatively their overprovision (i.e. smothering relationships or too-rigid social structures), can be harmful to mental health.

Crisis modelA sudden loss of a needed aspect of life

(bereavement for instance), or the threat of loss, can precipitate a crisis that can lead to acute changes in behaviour.

Caplan suggests however that a crisis does not automatically lead to psychological damage. It also presents an opportunity for personality growth, if the person is able to find the internal and external resources to handle the situation and resolve it.

Role of intervention – crisis modelA crisis is ‘a turning point toward or away

from mental disorder’Successful intervention can happen if the

person in crisis is offered the information, support and safe space to deal with the situation, find what resources they need to cope, learn new skills to prevent future crises, and integrate the experience.

Trauma model

Bloom argues that when people are subjected to repeated trauma this destroys the assumptions of personal safety that most people take for granted.

Victims of trauma may perceive the world as ‘no longer meaningful, or benevolent, and perceive themselves as worthless, helpless and hopeless’ (Bloom 1997 p.70).

Trauma model

They may become increasingly isolated from others, destroying their existing relationships and refusing to start new relationships.

Trauma can become their central organising principle.

Trauma modelIf children are exposed to danger repeatedly,

their bodies become unusually sensitive, so that even minor threats trigger this entire sequence of physiological, emotional, and cognitive responses. They can do nothing to control this reaction; it is a biological, built-in response, a protective device that goes wrong only if we are exposed to too much danger and too little protection in childhood or as adults (Bloom 1997 p.72).

Role of intervention –trauma modelHealing from trauma, Bloom argues, depends

on creating a safe social setting in which people who had been traumatised could be heard, understood, come to understand what had happened to them, grieve and share their grief, and begin to integrate their new knowledge to reconstruct their world.

Psycho-spiritual modelA crisis may result from a person’s attempts

at spiritual exploration or from the denial of spiritual needs

The developmental and transformative potential of a crisis should be emphasised.

Psycho-spiritual modelWhile there are many similarities between this

approach and the crisis model, in the spiritual model there is a far greater emphasis on spiritual transformation and the normality of spiritual phenomena such as visions.

Perry (1974) is a Jungian psychoanalyst and psychiatrist, who founded a pioneering crisis centre where young people experiencing a first episode of psychosis could be supported without medication.

Perry argues that the more undesirable outcomes of crisis are less likely if a healing environment and intensive support are provided.

Psycho-spiritual modelPerry (1989) describes psychotic episodes as a renewal

process, which temporarily overwhelms the individual in a prolonged visionary state. This he regards as nature's attempt to heal, rather than evidence of pathology. He concluded that psychic change does not happen smoothly, but is more like an earthquake or chaotic eruption.

His (Perry 1974) view of a schizophrenic crisis is that the psyche is seeking to reorganise on new lines, and that far from suppressing psychotic ideas and images, these should be seen, like dream images, as communications from the psychic depths which can aid psychic regeneration, reintegration and the creation of new order.

He noted that extreme turbulence tends to accompany profound changes in the psyche. People commonly talked of images of death and of the destruction of the world.

Role of intervention – psychospiritual modelPerry (1974) argues that the role of the

person who intervenes is to receive and work with whatever the person in crisis is communicating, rather than to treat their words and behaviour as symptoms of illness

Self-advocacy/empowerment modelan emerging ‘psychiatric survivor’ or ‘self-

advocacy’ discourse of crisis which is distinct from professional and academic discourses.

The key to this discourse is the power of the individual client, service-user or patient to self-define and to make choices

This is a fundamental contradiction to the discourse of psychopathology, which locates this power with psychiatrists.

Self-advocacy/empowerment modelpeople tend to relate personal distress

and tragedy in their lives to life problems such asabuse in childhooddifficult pregnancy and birthloss of employmentloss of relationshipextreme stresssuffering racism and violencefeeling alone and excluded

Self-advocacy/empowerment modelThe beliefs, thoughts and emotions people experienced are sometimes described by them in medical language, such as ‘depression’, ‘mania’, ‘paranoia’, or ‘phobias’

this may be because they have been diagnosed in this way by a psychiatrist or because such language is now part of common parlance via the media.

Self-advocacy/empowerment modelMany people describe their experience as a

‘breakdown’. People describe

thinking that they are being watched and talked about

experiencing terrible fear and anxietya compelling need to cry, hide and/or withdraw

from life, escape, or commit suicide.

Self-advocacy/empowerment modelSome talk about having lost touch with everyday reality, having encounters with pure light and energy, talking to or becoming spiritual beings or feeling they had lost their self or spirit.

Most people seem to have looked back in retrospect with a greater understanding of what had happened to them during their crisis.

Some people with these experiences have explicitly stated their aim to promote a new discourse in which the collective voice of patients can emerge

Self-advocacy/empowerment modelThis is a work in progress, but among its successes areHearing voices movementSurvivor run/led Crisis housesService user run servicesService user led researchInfluence on clinical psychologists, who in UK

are working with Hearing Voices movement and developing ‘functional’ approach as an alternative to diagnosis

Strengths approachRecovery model

References Anthony, W. (l993) Recovery from Mental Illness: The

guiding vision of the mental health service system, Innovations and Research,. 2 (3) 17-25.

Bloom, S. (1997) Creating Sanctuary: Towards the evolution of sane societies, New York: Routledge.

The British Psychological Society, Division of Clinical Psychology (2000) Recent advances in understanding mental illness and psychotic experiences, report, Leicester: The British Psychological Society.

Campbell, P. (1991) In Times of Crisis, OpenMind 52, 15.

_______ (1996a) Challenging Loss of Power, in J. Read and J. Reynolds (eds.) Speaking our Minds, Buckingham: Open University.

_______(1996b) What We Want from Crisis Services in J. Read and J. Reynolds (eds) Speaking Our Minds, Milton Keynes: Open University.

Caplan, G. (1964) Principles of Preventive Psychiatry, London: Tavistock.

Chamberlin, J. (1988) On our Own, London: MIND. Coleman, R., Baker, P. and Taylor, K. (2000) Victim to

Victor: Working towards Recovery, Gloucester: Handsell Publishing.

Curran, C. and Grimshaw, G. (1999) Advance directives, Open Mind 99,.24.

Curtis, T, Dellar, D., Leslie, E. and Watson B. (eds.) (2000) Mad Pride: A Celebration of Mad Culture, London: Spare Change Books

Grof, S. and Grof, C. (ed.)(1989) Spiritual emergency: When Personal Transformation Becomes a Crisis, New York: G.P. Putnam’s Sons.

Manic Depression Fellowship (1996) Inside Out: a guide to self-management of manic depression, London: Manic Depression Fellowship.

Michaelson, J. and Wallcraft, J. (1997) Alternatives to the biomedical model of mental health crisis, Breakthrough, 1 (3) 31-49.

Nelson, J.E. (1994) Healing the Split: Integrating Spirit Into Our Understanding of the Mentally Ill, New York: State University of New York Press.

Pembroke, L. (ed.) (1994) Self-Harm: Perspectives from Personal Experience, London: Survivors Speak Out.

Perry, J.W. (1974) The Far Side of Madness, Dallas, Texas: Spring Publications Inc.

Susko, M.A. (ed.) (1991) Cry of the Invisible, Baltimore: Harrison Edward Livingstone.

Wallcraft, J. and Michaelson, J. (2001) Developing a survivor discourse to replace the ‘psychopathology’ of breakdown and crisis, in C. Newnes., G. Holmes and C. Dunn (eds.) This is Madness Too, Ross-on-Wye: PCCS Books 177-190.

Wallcraft, J (2003 )-On Our Own Terms: Users and Survivors of Mental Health Services Working Together for Support and Change, The Sainsbury Centre for Mental Health