Man’s goings are of the Lord; how can a man then understand his own way? Proverbs 20:24

It is more difficult as a mental heath practitioner to work with persons who are living in deep psychotic states, it is even difficult to even imagine that such persons can be in remission of their symptoms and be back into functional states. Mostly when this happens to a family member or close associate feelings of bewilderment often arise as there are more questions than answers which can be provided.

Practitioners in the mental health, can have similar feelings with that of family and his close associates. Often this is seen with the type of treatment that the practitioner proffers to the client. Practitioners who view madness as an end to its self without hope of any person living with it, normally give the patient a very high dose of medication in the form of antipsychotics/ neuroleptics as a way to continuously manage the client without risk of relapse and without hope that the patient can improve without having medication. The medication is given for life and often results in extrapyramidal effects like tardive dyskinesia and or akathisia.

Persons living with psychosis often struggle with personal care. This makes it hard for persons to work with them. Persons with psychosis might also have nocturnal enuresis and struggle to bath which often makes them followed by a heavy stench which often makes personal contact and closeness difficult. Often persons with psychosis have dental challenges as they are unable to brush their teeth and this makes it hard for works to talk to them as they are often greeted with the hot heavy smell from their mouth. As a way to manage these persons and the challenges which they present, a care which is aloof is often proffered where a person is given psychopharmacological and left to their own care, without much contact to mental health personnel.

Initial interviews by persons with psychosis are often hard and even impossible. When persons with psychosis are in the prodromal and acute phase of these conditions it might be hard to commune with the persons and often, they can seem impervious to the therapist communication. It is because of these symptoms the patient present that informs the work of the therapist. The work starts by the views of the key informants usually these are the persons who have lived with the patient and at times do have deep experiential experience of the life of the patient at premorbid and morbid states. At these initial states of the clinical interviews therapeutic goals are created by the key informants and the therapist, the client views are with time in cooperated to the therapeutic goals as their symptoms remit. It is unfortunate that a paternalistic stance is taken, however such is done for the beneficence of the client and it highlights the genesis of the optimistic stance to care of those with psychosis. The optimism is in the sense that consultation is done with the hope that the patient is to improve with the contact or involvement of the therapist. The patient might at these initial interviews unaware consciously about such engagements and might not share similar aspirations to the extent that they might fight with persons seeking help on their behalf.

Once such initial engagements are done it becomes important that us as practitioners in mental health to proffer our services with optimism, what I call the optimistic care as shared by Basset et al in Psychosis Revisited. One major way to achieve this is to ensure that when use of psychiatric medication becomes needed it is given at minimal doses with the hope to discontinue the medication as functional outcomes increase and symptoms remit. This optimistic care mimics the Finnish Dialogical Therapy of 1992 and involves all stakeholders in the care of the patient. I do hope as we move within this trajectory of optimistic hope, we are able to subdue the oblivion and frustrations of these conditions which people bring to therapy and help persons to live beyond psychosis and the perturbations it present.

Prosper K Mushauri

Counselling Psychologist