Our Uncertainty About What is Real Drives an Othering of Those With Alternate Realities

Our Uncertainty About What is Real Drives an Othering of Those With Alternate Realities - Irene Hurford, MD
This presentation was a session at the ISPS-US 2023 National Conference in Newark, DE. Thank you to our sponsors, Advocacy Unlimited (advocacyunlimited.org/) and CORAS Wellbeing and Behavioral Health (coraswellness.org/).
ISPS-US promotes psychological and social approaches to states of mind often called "psychosis" by providing education, training, advocacy, and opportunities for dialogue between service providers, people with lived experience, family members, activists, and researchers. Get involved by attending our educational events or joining us as a member to access our network of support, discussion and peer supervision groups, creative sharing spaces, our journal, and more.
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Description
I have been a practicing psychiatrist for 20 years, many of those in academia. I developed, ran, and trained programs for first-episode psychosis in Pennsylvania. This model, like almost all models of care in the US for psychosis, still pit the individual's reality against consensus reality. Yet I have seen that those who choose to work in these programs have good intentions. They believe in recovery and resilience. What is the barrier to true empathy?
Why is it so uncomfortable to sit with other people's alternate experience of reality, without defending ourselves against it? The discomfort associated with listening to an alternate reality is visceral. It disorients us, makes us angry. What is at stake? In my experience working with people with psychosis, the stakes are as high as any. For those on both sides of the treatment experience, the stakes are existence vs. annihilation.
For all of us, reality is tenuous at best. Phones ring when there is silence, shadows are strangers in the dark. People are too interested in our business, perhaps they are conspiring against us. We are constantly trying to bolster a shaky consensual reality. Sitting without judgment with those whose views of reality clash with our own is to throw ourselves into existential chaos. It is a hard thing to allow. But without finding a way to be brave enough to acknowledge in ourselves the unknown, we leave those we profess to treat in the isolation of their own existential experience. In the hands of doctors too afraid of the abyss of uncertain reality, medications become a tool to erect a barrier between us and them. Instead, medication should be used with caution, and at the smallest doses, as the costs of high-dose medication are as great or greater than that of an unshared reality.
About the Presenter
Irene Hurford, MD
Dr. Hurford graduated Summa Cum Laude from the University of Toronto, and received her MD from McMaster University in Hamilton, Ontario. She was chief resident during her residency at UCLA, and completed a two year research fellowship in San Diego. Dr. Hurford was faculty at the University of Pennsylvania for ten years, and she continues to be volunteer clinical faculty in the department of Psychiatry at the University of Pennsylvania. Dr. Hurford was founder and clinical director of the Psychosis Education, Assessment, Care, and Empowerment (PEACE) program at Horizon House, Inc, which has become a leading First-Episode Psychosis (FEP) program across the United States. She was the founder and director of HeadsUp at the University of Pennsylvania, where she led Pennsylvania-wide efforts at FEP services program evaluation, and programmatic training in FEP Coordinated Specialty Care service implementation and delivery. Dr. Hurford is the recipient of multiple awards, including the 2017 NAMI National Exemplary Psychiatrist award, and 2017 NAMI Montgomery PA Impact Award.

[@fuzbugg]

incredible talk! I love the interweaving of your own family experience with your work and the analysis of why the system is so harsh on people with this kind of very human experience... I remember in my case my family being extremely frightened of me and of the situation I think that this is very common

[@upendasana7857]

I am so grateful for all these alternative perpectives on how to respond to those ina mental health crisis but it is also very depressing that after more than 30 years since I and my family forst came into contact with the mental health system that so little has changed and those at the margins trying to change the default response of drugs drugs drugs and still so few other therapeutic options available and truely trying to understand the subjective reality of what someone might be going thorugh and not objectfiy them as the
"sick one",the one that needs to be "fixed",the one that is "abnormal","delusional","out of touch with reality",when so often the onlookers are themselves looking through the prism of their own dysfunctions and limited perspectives of reality.