Abstracten voor Need-adapted care for psychosis

Hier vind je enkele abstracten van de sprekers
op de studiedag van de ISPS “Need-adapted care for psychosis”

. The role of chance in the power of interaction. Francoise Davoine.
. De omgeving van de mens is de medemens. Caroline Verheijde-Zeijl.
. Impact van gemandateerde repatriëring op culturele identiteit van forensisch psychiatrisch opgenomen patiënten in een transcultureel ziekenhuis. Charlotte Clous
. Zorgpraktijken rondom identiteit en zin. Elske Kronemeijer
. Het “zelf” in schizofrenie-spectrum stoornissen: kritische bespreking van het fenomenologische zelfstoornis-model en klinische implicaties. Jasper Feyaerts.

. “Coconuts”. Herstel in de stad: Ondernemen tot kwaliteit. Niel Van Cleynenbreugel
. De reis naar genezing van geestelijke ziekten begrijpen en beheren. Luc De Bry
. Omarmd in een gezinscontext versus opgesloten in psychiatrie tijdens psychose.
Christel Guldentops

. Euthanasie bij psychiatrische aandoeningen: complexer dan gedacht. Ludi Van Bouwel
. “10 jaar ervaring met Soteria in Nederland – geleerde praktijklessen & (internationale) onderzoeksbevindingen”, Pien Leendertse

Francoise Davoine.
The role of chance in the power of interaction.

When they start a new life, people with lived experience of trauma and psychoses, especially under conditions of past or present war, often ask the question: “By what coincidence did I meet you?”I will contend that the power of interaction arises from such interferences with the psychoanalyst and caregivers, giving breath, rhythm and voice to silenced abuses. I will give clinical examples, knowing that I speak in the country of the Kalevala.

Caroline Verheije-Zeijl.
De omgeving van de mens is de medemens.

It is known that social factors such as exclusion, ethnic identity and ethnic density play a role in the development of psychotic disorders and other psychopathology. In this workshop we provide tools to strengthen embeddedness and ethnic identity based on insights from transcultural systems therapy. After a theoretical introduction participants will get the opportunity to practise with some tools. Themes of this workshop include personal family customs and sacred cows, protective wraps, authority figures, ‘me’ and ‘we’ cultures.

Charlotte Clous
Impact van gemandateerde repatriëring op culturele identiteit van forensisch psychiatrisch opgenomen patiënten in een transcultureel ziekenhuis.

Learning objectives 

This paper aims to highlight the particular intricacies of cultural identity manifested in migrant forensic psychiatric patients with a psychotic disorder who face mandatory repatriation to their country of origin. 

Cultural identity and discrimination might be drivers of the increased psychosis risk observed in ethnic minorities. Ethnic density theory indicates that experiences of sociocultural inclusion counterpose the effects of social exclusion in maintaining the balance of mental health. This study aims to provide insight into processes of identification and their role in pathways to recovery of ethnic minority forensic psychiatric inpatients for whom mandatory treatment ends in a return to their country of origin. 

We have used  anthropological hospital ethnography methodology in a single forensic psychiatric clinic in the Netherlands. In this longitudinal study, we combined observations, three rounds of in-depth interviews and focus groups to facilitate data triangulation. Participants were eligible for inclusion if they had a diagnosis of a psychotic disorder, were aged >18 and were facing mandatory repatriation to their country of origin. 


We recruited a total of twelve participants across four wards. Preliminary analyses from the first round of interviews and focus groups suggest that, in telling and re-telling their life stories where loss, trauma, stigma and exclusion prevail, they show remarkable resilience and hope, negotiating present positions and imagining future scenario’s through values such as respect, trust, loyalty and responsibility. Full results will be presented at the conference.

How ethnic minority patients under hospital orders experience and reflect on the question of having to go ‘back to where they once came from’ offers insight into affective, strategic, personal and intersubjective dimensions of cultural identity and how they take shape under the influence of daily experiences in daily encounters of clinical care. 

Biographical sketch 

Charlotte Clous is a medical anthropologist working in a Dutch transcultural forensic psychiatric clinic, CTP Veldzicht. As a PhD candidate at the University Medical Centre of Groningen, department of psychiatry she is involved in ethnographic research focussing on cultural identity of ethnic minority forensic inpatients with a psychotic disorder and loss of Dutch residency rights. 

Elske Kronemeijer.
Zorgpraktijken rondom identiteit en zin.

A Survey Exploring Identity-based Care Practices for People with a Severe Mental Illness

Background: A severe mental illness is often accompanied by negative experiences such as a sense of loss, stigmatization and difficulties to participate in society. These disruptive experiences can influence how people with severe mental illnesses view themselves, for example because they develop a more negative or stigmatized self-concept. Though many practitioners are willing to support patients with these identity struggles, few identity-based interventions have been developed and described scientifically. Spiritual caregivers, psychologists, psychiatrists, and experience experts talk on a daily basis with patients about their self-views and life narratives, but may have different approaches and perspectives regarding good practices.

Approach: The aim of the current survey was to explore how practitioners approach identity in their work with people with a SMI, for example through specific interventions, tools or discussion topics (e.g. life stories, meaning making). The survey was distributed online through different health care institutions and practitioner networks in the Netherlands. 190 practitioners filled in the open- and close-ended questions. Answers were analyzed descriptively and with qualitative content analysis.

Results and implications: Health care practitioners use various interventions, such as reflection cards, games, psychosocial interventions and less structured activities. Topics that are most often discussed include topics related to the life story, social contact and activities. Other topics, such as body image, are discussed less frequently in the context of identity. The results of this research can inform intervention development. Results are also relevant for further research into identity development for people with severe mental illnesses.

Kronemeijer E 1,2,5 , Muthert H 3 , van Setten E 5 , Pijnenborg M 1,4 , Van der Meer L 1,2,5

1 University Of Groningen, Department of Clinical and Developmental Neuropsychology, The Netherlands

2 Lentis Center for Mental Health Care, Zuidlaren, The Netherlands

3 University Of Groningen, Faculty of Religion, Culture and Society, Groningen, The Netherlands

4 GGZ Drenthe, Assen, The Netherlands

5 Group for Rehabilitation and Innovation in Psychiatry (GRIP), Groningen , The Netherlands

Hieronder nog een posterbestand van Elske Kronemeyer

Jasper Feyaerts.
Het “zelf” in schizofrenie-spectrum stoornissen: kritische bespreking van het fenomenologische zelfstoornis-model en klinische implicaties.

From welcoming a psychotic crisis to its treatment: psychoanalytic and phenomenological perspectives.

A psychotic crisis implies a radical change in the way people experience themselves and the world. In this symposium, we aim to reflect on the nature of crisis, the shelter for it and therapeutic strategies from broadly psychoanalytic and phenomenological clinical perspectives.

The first presentation focuses on the therapeutic relation during a mental crisis and its consequences for the therapist. The image of dancing together on a slack rope is used to reflect on the balancing of the therapeutic alliance, e.g., between space and boundaries, sensicality and non-sensicality, tragedy and comedy.

The second presentation discusses the ward and its protective and therapeutic function as an asylum. Guiding questions are the following: In what sense can the ward operate as a place where a psychotic crisis finds a space and boundary? How can it be organized to function as a ground for the (re)establishment of a relation with the other, the surrounding world and the self in psychosis? Is it possible to install a phorical function within the ward that allows to create a semaphorical and a metaphorical process?

The third speaker adresses the first-person experience of the psychotic crisis, focusing on the phenomenological nature of alterations of self and reality in psychosis. This presentation provides a critical discussion of the so-called basic self-disturbance model of schizophrenia, emphasizing heterogeneous aspects of self -and reality-experience that are central to psychosis. Implications for research models, clinical approaches and our general understanding of the experiences in question will be discussed.

Niel Van Cleynenbreugel
“Coconuts”. Herstel in de stad: Ondernemen tot kwaliteit.

Coconuts: Urban Recovery
I will ask you an important question. The answer has the potential to change your entire life. It will rewrite your existence. Consider it a last chance; after this, there is no turning back. A chance for more, a chance for enlightenment, a chance to escape. Like everyone, you were born into slavery, born into a prison you cannot smell, taste or touch. Mental captivity. I ask you to make a choice between two pills.
If you take the blue pill, the story ends here, and you wake up in your bed believing whatever you want to believe. You discover nothing new, and you can continue to enjoy what you were doing. The world you know, as you know it, remains for you.
If you take the red pill, you stay in Wonderland, and I will show you how deep the rabbit hole goes. Together we will take a closer look at Coconuts and explore what we learned after 1 year on the border of mental health, the creative sector, and the social enterprise world. We ask critical questions about our operation and hope to search for the revolution towards the evolution of recovery together with you. Seeking the best need-adapted care that Coconuts can endure.
Inspire and be inspired.

Coconuts is a creative place, in Leuven (Belgium) for young adults with a psychotic experience. We offer them space to find their place in society (again) and to (re)connect with their enthusiasm for life through art, design and social entrepreneurship.

Luc De Bry.
De reis naar genezing van geestelijke ziekten begrijpen en beheren.

De reis naar genezing van geestelijke ziekten begrijpen en beheren.

Luc De Bry, Ph.D. luc.de.bry@skynet.be
1) Vader van een Zoon met 7 diagnoses, schizofrenie, autisme, anorexia, enz.;
2) Wetenschappelijk Onderzoeker die bijdraagt aan de ontwikkeling
van voedings-, psychologische en medische wetenschappen;
3) Vrijwilliger om lijders van geestesziekten te helpen te genezen;
4) Lid van VZW Similes-Vlaanderen, VZW UilenSpiegel, VZW ANBN, ASBL EspéranceS, ASBL Similes-Bruxelles, VZW/ASBL Psychedelic Society of Belgium, ASBL Similes-Wallonie.

Laten we eerst onthouden dat het woord “Geneeskunde” de “Kunst van het Genezen” betekent!
Sinds de jaren 1970, dankzij de gepubliceerde resultaten van de World Health Organisation (WHO), het Soteria experiment, het Nederlandse en Britse Hearing Voices onderzoeksteams, het Open Dialogue team van de provincie West Lapland in Noord-Finland, en vele individuele onderzoekers, werd het meer en meer bekend en begrepen dat het mogelijk is om mentale ziekten die kinderen, tieners en jonge volwassenen treffen, zoals autisme, ADHD, anorexia, boulimia, eetbuistoornis, bipolariteit en schizofrenie, te genezen.
Volgens het DSM-V, lijden 13,6% van de bevolking van deze geestesziekten. In België zijn dit 1,6 miljoen patiënten die verstoken blijven van adequate genezing.

Dit moet veranderen!
Daarom beginnen we met een overzicht van curatieve therapieën voor psychische aandoeningen. die in verschillende delen van de wereld worden gebruikt en hoe ze elkaar aanvullen.
Er zijn 5 hoofdfasen in de genezingsreis te beheren, ofwel medisch, ofwel sociaal-psychologisch.
Enerzijds autisme, ADHD en 15-20% van de psychosen, zijn symptomen van ziekten die medisch geanalyseerd, behandeld en genezen kunnen worden door integratieve geneeskunde en waarvan de belangrijkste oorzaken auto-immuunziekten zijn. Anderzijds worden eetstoornissen en 80-85% van psychotische stoornissen veroorzaakt door een opeenstapeling van trauma’s uit de kindertijd en adolescentie.
De ziekte die genezen moet worden door sociaal-psychotherapie en neuroplasticiteit is de “Confirmed Negativity Condition (CNC)“, een verschrikkelijk monster dat lijders tot waanzin drijft.
Hallucinaties en woede moeten worden uitgedrukt en niet onderdrukt. In landen zoals België, waar therapieën om mentale ziektes te genezen (nog) niet terugbetaald worden door het RIZIV, zijn er twee belangrijke voorwaarden om ondanks alles toch te genezen.

Ten eerste moet je loskomen van de institutionele en dogmatische psychiatrie die beweert dat de genoemde geestesziekten ongeneeslijk zijn.
Ten tweede moet de reis naar genezing, zoals elke reis, goed voorbereid en ondersteund worden.
Hier beschrijven we de vereisten waaraan moet worden voldaan om een kwalitatief hoogstaande voorbereiding te garanderen met het oog naar genezingssuccess.
Tot slot tonen een kwaliteit/prijsanalyse en een op activiteiten gebaseerde kostenberekening (Activity Based Costing = ABC) aan dat iedereen erbij wint met de sociale psychiatrie die werkt aan de genezing van patiënten. De geleverde Kwaliteit is genezend en de Prijs is 15 tot 40 keer goedkoper dan institutionele psychiatrie.
Voor de belastingbetaler is de inzet van de paradigmaverschuiving van institutionele psychiatrie, die patiënten niet geneest, naar sociale psychiatrie, die patiënten geneest, een jaarlijkse besparing van 25 tot 30 miljard euro. De reis naar het genezen duurt gemiddeld 5 jaar. Eens genezen kunnen ex-lijders van geestesziekten voltijds studeren, werken en belastingen betalen.
In conclusie, is het genezen van geestesziekten een uitstekend socio-businessmodel.
Academische referentie [2021], geindexeerd door PubMed [2022]: https://pubmed.ncbi.nlm.nih.gov/34840177/ 

Christel Guldentops
Omarmd in een gezinscontext versus opgesloten in psychiatrie tijdens psychose.

Op mijn achttiende kreeg mijn moeder de diagnose “schizofrenie”. Ik was getuige van haar lijden,  zag hoe zij zwaar gemedicaliseerd werd als nagenoeg enige “therapie” en hoe zij tot slot voor het leven werd gehospitaliseerd. Terwijl ik me afvroeg of deze “veroordeling” erfelijk was, besloot ik er alles aan te doen wat in mijn macht lag om niet dezelfde weg op te gaan.

ACE ’s die leidden tot toxische relaties in mijn twens en de dood van enkele geliefden resulteerden in een crisis met rand psychotische ervaringen op mijn dertigste. Ik overwon dit en kon mijn studies van dierenarts afmaken en korte tijd werken. In 2010 geraakte ik opnieuw in crisis door pesterijen van mijn baas. Sedertdien deed ik elke vijf jaar trauma gerelateerde psychoses tot 2020, wanneer ik de voorlaatste keer gehospitaliseerd werd.

Gedurende mijn een na laatste psychotische episode, in de lente van 2023, werd ik opgevangen bij vrienden thuis. Ik kreeg er een bed, gezonde voeding en regelmatige knuffels en babbels. Samen zochten en vonden we betekenis in mijn “gekte”, rekening houdend met mijn oude wonden.

Dit staat in schril contrast met mijn eerste ervaringen in de psychiatrie. De “behandeling” in het ziekenhuis herinnert me vaak aan wat ik als kind doormaakte. Het betekende opnieuw controleverlies, dus meer trauma, en was daarom niet behulpzaam. Het verblijf bij mijn vrienden daarentegen wel. Ik herstelde binnen enkele weken in plaats van de negen maanden die ik nodig had om te bekomen van mijn eerste ziekenhuiservaring. Ik ben er van overtuigd dat dit de reden is waarom zoveel mensen in het systeem verloren geraken.

Ludi Van Bouwel en Marc Calmeyn en Margreet de Pater
Euthanasie bij psychiatrische aandoeningen: complexer dan gedacht.

Ludi Van Bouwel: Different perspectives of a strong wish to die and how to cope with it. 

A psychiatrist-psychotherapist is often consulted and confronted with severe mental suffering and the wish to die by his patient. The psychiatrist explores the meaning of this suffering, tries to place this suffering in a broader context, creates the possibility to transform suffering into a bearable experience and always places hope for change at the centre of his therapy. It is the task of the psychiatrist/psychotherapist to investigate both the intrapsychic and the interpersonal dynamics of a strong wish to die. 

When a question for euthanasia arises in the person who suffers, a psychiatrist/psychotherapist can be assisted by disciplines that go beyond the purely medical. First and foremost there is psychoanalysis with concepts such as Eros and Thanatos, transference and counter-transference, fusional empathy and containing empathy. Secondly ethical considerations as well as the recovery vision can provide guidance when desperation threatens the therapeutic relationship. Finally, cultural, historical and philosophical ideas from Classical Antiquity, Christianity and existentialism offer concepts that can deepen and give meaning to the relationship. In this way, despair can be transformed into hope and a new connection with the world and with others can originate, even when life seems hopeless or absurd. 

Affiliations: Ludi Van Bouwel is psychiatrist/psychoanalyst, member of the Belgian School for Psychoanalysis, member of the board of ISPS Low Lands, member of the EC of ISPS of which she is past chair. (She has been psychiatrist on a ward for young adults with psychosis vulnerability at the University Psychiatric Centre of the Catholic University of Leuven and started an early intervention team for treatment of psychosis in the community in Belgium.) 

Marc Calmeyn: Euthanasia for mental suffering: the autonomy of an illusion 

When persons ask euthanasia for mental suffering they don’t want this unbearable life anymore, but they don’t actually want to die. They as well as the professionals have a blind spot for it. 

Even more, two basic concepts challenges the dominant discourse on euthanasia for psychic suffering. First, psychopathology is dynamic in its origin, changes are always possible. Secondly, the therapeutic relation is the core of treatment. So in another therapeutic context change can occur. It means that one can never predict that a mental disorder is unchangeable and untreatable. 

As a conclusion two basic assumptions leading to this dead-end street are presented: the illusion of absolute autonomy and a misunderstanding of the concept of empathy. 

Affiliations: Marc Calmeyn psychiatrist psychoanalyst, member of the Belgian School for Psychoanalysis. He is working in private practice. He is an expert at the Superior Health Council of Belgium. He has written a book ‘Depressie is menselijk’ (depression is humane). 

 Margreet De Pater: The seduction of death 

 In my job as a community psychiatrist I met many people who wanted to die for understandable reasons. A few committed suicide and my experience is that a psychiatrist has no power to prevent this when people want to die for 100 %. 

Mostly the death wish was ambivalent however, people told me that when I asked after a ‘’failed’’ attempt. Discussing pro and cons on what motivates the death wish, discussing feelings and thoughts can be lifesaving. 

However In our individualistic culture clinicians often overlook the interaction between patient and other people and fantasies about this. ‘’I’m a burden for everyone, people are better off without me.’’ I was told many times. When I checked these fantasies in a family conversation asking: ‘’How would it be for you to bury him?’’ loved ones often burst in tears. But yes, sometimes people were really a burden, then other solutions could be found like loved ones setting limits to behavior. 

There is another source for suicidal behavior. Our mental system can be experienced as very totalitarian for people who must be ‘’cured’’, committing suicide can be seen as resistance, a way to conquer freedom. Resulting in a circle of coercion and resistance very harmful for everyone. Could the possibility to get euthanasia be a remedy to prevent this harmful circle? 

In my talk I will try to give some answers. In countries were euthanasia is permitted are there less suicide attempts resulting in less deaths in the end? 

Affiliations: Margreet De Pater: retired community psychiatrist, chair of ISPS Low Lands en member of the EC of ISPS. She is one of the moderators of the ISPS-INT email discussion list. 

Pien Leendertse.
“10 jaar ervaring met Soteria in Nederland – geleerde praktijklessen & (internationale) onderzoeksbevindingen”.

Hieronder vind je een posterbestand van Pien Leendertse