The stress vulnerability model was proposed by Zubin and Spring (1977). It proposes that an individual has unique biological, psychological and social elements. These elements include strengths and vulnerabilities for dealing with stress.
In the diagram above person “a” has a very low vulnerability and consequently can withstand a huge amount of stress, however solitary confinement may stress the person so much that they experience psychotic symptoms. This is seen as a “normal” reaction. Person “b” in the diagram has a higher vulnerability, due to genetic predisposition for example. Person “c” also has genetic loading but also suffered the loss of mother before the age of 11 and was traumatically abused. Therefore persons “a” and “b” take more stress to become “ill”.
This model is obviously simplistic. However it does help with the understanding of psychosis. Vulnerability is not a judgmental term but a different way to approach the variables involved. We all have a different capacity to take on stress depending on how vulnerable we are. At different times in our lives we can be anywhere on the curve, depending on these variables.
Increasing coping skills or altering environmental factors (family, work, finance, housing etc.) and specialist help can reduce vulnerability and build resilience. Attending a peer group may help to build self-efficacy, self-esteem and self-acceptance all of which may be protective against relapse and form a buffer to demoralisation. It gives hope!
It was Tuesday. My day off work. It was bright and sunny.
We went to see the doctor for the last time.
We were late by a few minutes because I made him shave. I got a bit annoyed about the fact that we got late but then I hugged him and apologised.
It didn’t matter because we still had to wait.
It was our last chance to pick up on how unwell he was.
He was in ‘crisis’ but we didn’t recognize it.
Not even his doctor did.
We went to the bank, the fruit shop, the gift shop, the Oxfam charity shop and the post office. We had soup for lunch out in the open at the local organic food deli. Although we were together he was very much coming along with me. I loved that he was spending time with me. Sometimes I even succeeded in making him laugh. For instance one day he told me about a friend who spoke to him about his Mum being really annoying and pushy, to which I said, “Well. That seems to be the flavor of the month.” And he gave me one of his lovely sideways smiles acknowledging my remark. I felt fantastic whenever I could achieve that. It was not easy.
He went to his room for a nap. I called my brother in India. I cried on the phone as my heart was breaking. I felt helpless and powerless to change anything. Instinctively I knew we were missing something but I didn’t know what.
It is easy to identify psychosis in someone who is wielding a knife standing in the kitchen but not so in someone who makes no fuss and quietly sits in his room. Depressive psychosis is sinister.
The date has come back but the day is gone forever.
Our last full day together.
A couple of days ago I delivered a talk on ‘Psychosis’ to a group of friends interested in mental illnesses in the young. I didn’t spend much time in preparation although I did think deeply about it. On the day, I was surprised by the expressions that came out of my mouth. I was describing concepts that I had only ever visualized in my head. For instance, if we were to think of a physical equivalent of Psychosis, it would be as if someone was bleeding profusely. Their soul is bleeding. They are suffering great pain from a deep hidden wound. It felt as though I was saying things on behalf of my son, uttering the words that he could not, speaking authentically from experience.
When asked for feedback from the audience, there was silence for about 10 seconds after which someone said, “Mesmerising!” I was not bothered about the fact that I was ‘performing’ and was definitely not worried about what anyone thought. I just wanted to share my experience and understanding of psychosis so they could identify it when they saw it and know what to do about it.
Terry Pratchett has said, “Wisdom comes from experience. Experience is often a result of lack of wisdom”.
It seems as though I am being remoulded by my experiences. It makes sense and feels natural to be doing these kinds of things. It is like being in a fresh new clearing in the forest.