Compassion in Schizophrenia: Impact and Healing
Compassion and Schizophrenia:
climbing the pyramid
Mark Ellerby
Expert by experience
Durham
Maslow (1954)
Hierarchy of needs
schizophrenia
•
The two main symptoms of my
schizophrenia are hearing critical voices
and having paranoid delusions.
Impact from schizophrenia
Voices,
delusions,
paranoia
The impact of schizophrenia on
Maslow’s hierarchy
•
paranoid delusions are frightening and make
us feel unsafe (Maslow’s second tier)
•
and make it difficult to trust people, which
may have acted as a source of strength (third
tier).
•
hearing critical voices attacks our self esteem
(Maslow’s fourth tier).
•
It is difficult to put energy into creativity when
attention is pulled to threats.
T
T
y
y
p
p
e
e
s
s
o
o
f
f
A
A
f
f
f
f
e
e
c
c
t
t
R
R
e
e
g
g
u
u
l
l
a
a
t
t
o
o
r
r
S
S
y
y
s
s
t
t
e
e
m
m
s
s
Incentive/resource-
Incentive/resource-
focused
focused
Wanting, pursuing,
achieving, consuming
Activating
Non-wanting/
Non-wanting/
Affiliative focused
Affiliative focused
Safeness-kindness
Soothing
Threat-focused
Threat-focused
Protection and
Protection and
Safety-seeking
Safety-seeking
Activating/inhibiting
Activating/inhibiting
Anger, anxiety, disgust
Anger, anxiety, disgust
Drive, excite, vitality
Drive, excite, vitality
Content, safe, connected
Content, safe, connected
How can compassion help me
•
Using the compassion in soothing the fear
caused by the paranoid delusions opens up
different possibilities for action and reflection.
•
Compassion allows connectivity and empathy
towards other people and should be useful
for generating progress on the emotional
level and relational levels.
•
Soothing the self critical voices removes a
barrier to and opens up the possibility of
generating self esteem and maybe moving to
the self actualisation level.
Compassionate facilitation
reduction
in criticism
to self and
paranoia
Compassion helps esteem needs by reducing our self critic.
Compassion helps relationhshps by reducing our fears of what others think of us.
Compassionate wards
•
H
o
s
p
i
t
a
l
w
a
r
d
s
c
a
n
h
i
n
d
e
r
r
e
c
o
v
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r
y
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c
a
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s
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h
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p
a
t
i
e
n
t
s
a
n
d
n
u
r
s
e
s
a
r
e
n
o
t
s
h
a
r
i
n
g
c
o
m
p
a
s
s
i
o
n
a
t
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c
o
n
v
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r
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n
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a
r
e
l
e
f
t
t
o
w
a
t
c
h
t
h
e
T
V
.
•
less emphasis on the medical model which in
effect amounts patients getting drugged on tablets
instead of active and interactive.
•
Compassionate training on the part of nurses and
keeping the patients would overcome the threat
system. This key to understanding this could be
seen as providing more of a ‘affiliative'
atmosphere.
Family support
•
Maintaining close family support
(particularly with compassionate relatives)
is a way of building emotion strength
against voices and delusions but also
helps develop the emotional tier of the
maslow tree in profound ways.
•
if family contract is restricted by wards this
is going to be more difficult.
Accommodation
•
S
h
e
l
t
e
r
e
d
A
c
c
o
m
m
o
d
a
t
i
o
n
i
s
j
u
s
t
t
h
a
t
i
e
S
h
e
l
t
e
r
e
d
a
n
d
i
s
p
o
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s
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o
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r
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o
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f
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y
n
e
e
d
s
o
f
s
e
r
v
i
c
e
u
s
e
r
s
.
Day services
•
D
a
y
c
e
n
t
r
e
s
a
r
e
p
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a
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e
s
w
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a
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a
i
m
o
f
s
u
c
h
p
l
a
c
e
s
.
•
For Gilberts therapy it was important to expand our emotional
and achievement circles to help overcome or soothe the
threat system. I think the courses on offer at day centres and
making friends there in safe non stigmatising environment will
help further overcome the threat circle and help us climb the
Maslow tree
•
Esteem
•
Kristen Neff found that self esteem,
Maslows fourth tier, depends a lot on our
position in society and how far up we are
in the social hierarchy.
•
This is going to be particularly problematic
for mental health patients because few of
them have the opportunity to work. They
also experience stigma, external shame
and isolation from others.
Stress-vulnerability
•
we all have different thresholds for stress and
how vulnerable we are to be tipped over the
edge.
•
It is useful to know what the triggers are and
how to build resilience. I am learning
mindfulness, breathwork, to use an image of
me at my best, to rebuild friendships, to have
courage to go out of the house.
•
I am learning to change the relationship to
my voices so I am less submissive…that is a
challenge!
Issues with maslow
•
Erickson argues that it is possible to climb
the maslow tree without having to do it
level by level.
•
So it may be possible to get some self
esteem or emotion level even when
frightened.
I have noticed….
•
when I eventually calm down, I return to a
normal emotional state and go from threat to
safeness…. and vice versa when frightened.
•
this seems to point to the fact that climbing
the Maslow tree may be possible with
schizophrenia
•
Compassionate support from services and
family will help this journey.
•
CFT has given me some hope.
Compassion plays a crucial role in managing schizophrenia by soothing fears, reducing self-criticism and paranoia, and enhancing self-esteem and relationships. By fostering empathy and connectivity, compassion opens up avenues for emotional and relational progress, potentially aiding in self-actualization and overall well-being.
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Presentation Transcript
Compassion and Schizophrenia: climbing the pyramid Mark Ellerby Expert by experience Durham
Maslow (1954) Hierarchy of needs
schizophrenia The two main symptoms of my schizophrenia are hearing critical voices and having paranoid delusions.
Impact from schizophrenia Voices, delusions, paranoia
The impact of schizophrenia on Maslow s hierarchy paranoid delusions are frightening and make us feel unsafe (Maslow s second tier) and make it difficult to trust people, which may have acted as a source of strength (third tier). hearing critical voices attacks our self esteem (Maslow s fourth tier). It is difficult to put energy into creativity when attention is pulled to threats.
Types of Affect Regulator Systems Content, safe, connected Drive, excite, vitality Non-wanting/ Affiliative focused Incentive/resource- focused Safeness-kindness Wanting, pursuing, achieving, consuming Soothing Activating Threat-focused Protection and Safety-seeking Activating/inhibiting Anger, anxiety, disgust
How can compassion help me Using the compassion in soothing the fear caused by the paranoid delusions opens up different possibilities for action and reflection. Compassion allows connectivity and empathy towards other people and should be useful for generating progress on the emotional level and relational levels. Soothing the self critical voices removes a barrier to and opens up the possibility of generating self esteem and maybe moving to the self actualisation level.
Compassionate facilitation reduction in criticism to self and paranoia Compassion helps esteem needs by reducing our self critic. Compassion helps relationhshps by reducing our fears of what others think of us.
Compassionate wards Hospital wards can hinder recovery because the patients and nurses are not sharing compassionate conversation and are left to watch the TV. less emphasis on the medical model which in effect amounts patients getting drugged on tablets instead of active and interactive. Compassionate training on the part of nurses and keeping the patients would overcome the threat system. This key to understanding this could be seen as providing more of a affiliative' atmosphere.
Family support Maintaining close family support (particularly with compassionate relatives) is a way of building emotion strength against voices and delusions but also helps develop the emotional tier of the maslow tree in profound ways. if family contract is restricted by wards this is going to be more difficult.
Accommodation Sheltered Accommodation is just that ie Sheltered and is possible to contribute to the safety needs of service users.
Day services Day centres are places where people can talk to each other and develop compassion through witnessing each others suffering. From here friendships and relationships can develop strengthening the emotional level of the tree still further while compassion may give patients the emotional strength to support work and independent living outside the mental health system which is the ultimate aim of such places. For Gilberts therapy it was important to expand our emotional and achievement circles to help overcome or soothe the threat system. I think the courses on offer at day centres and making friends there in safe non stigmatising environment will help further overcome the threat circle and help us climb the Maslow tree
Esteem Kristen Neff found that self esteem, Maslows fourth tier, depends a lot on our position in society and how far up we are in the social hierarchy. This is going to be particularly problematic for mental health patients because few of them have the opportunity to work. They also experience stigma, external shame and isolation from others.
Stress-vulnerability we all have different thresholds for stress and how vulnerable we are to be tipped over the edge. It is useful to know what the triggers are and how to build resilience. I am learning mindfulness, breathwork, to use an image of me at my best, to rebuild friendships, to have courage to go out of the house. I am learning to change the relationship to my voices so I am less submissive that is a challenge!
Issues with maslow Erickson argues that it is possible to climb the maslow tree without having to do it level by level. So it may be possible to get some self esteem or emotion level even when frightened.
I have noticed. when I eventually calm down, I return to a normal emotional state and go from threat to safeness . and vice versa when frightened. this seems to point to the fact that climbing the Maslow tree may be possible with schizophrenia Compassionate support from services and family will help this journey. CFT has given me some hope.
