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WEEK 2: Complex, comorbid and chronic disorders
Lecture 3 (video lecture): Interview with expert-by-experience on psychosis, trauma and recovery
Expert-by-experience: Jeroen Zwaal, has experienced psychosis several times. Arts will have a prominent place in
his story.
Theme 1: First experience with psychosis
When he was six your old there were problems in his home situation. He is the youngest of four children. He
was six years old when he experienced his first odd situation at home (which was put into a secret/taboo).
His brother experienced psychosis several times as well. His brother became the black sheep in the family.
When Jeroen was fifteen years old, his mother passed away. The situation at home was tense. He and his
mother were really close.
When he was eighteen years old, he was still worried about his father, mourning about his mother and he
could not sleep for twee weeks. He thought: I can only remove my worries if I understand them. His head
started spinning. He learned that images were helpful for him. He got an image and could move around in
this image. His teacher could not understand his symbolism. Jeroen developed some sort of language for
himself, with metaphors, to express himself because he could not express himself in words. He lost
connection with reality, there was a lot of tension, loss of sleep. Instead of a dream and waking up from it, it
became worse for Jeroen and it did not stop. He thought there were problems with his father (instead of
him). Jeroen needed help, but there was not any.
He had an interview for the military (dienstplicht) and they did not understand him at all. They felt there was
something wrong, but they did not do anything with it. He experienced a sort of social delusion afterwards,
like he was giving a special assignment. The rejection of the army he experienced as positive, like there
was something else better suited for him.
Displayed odd social behavior:
o Stepping into a random car; Can you drive me home? The police came and once the police horse
stepped on his foot, he came back to reality
o Fight with father: he came home and became mad without a clear reason. For him it was like he
experienced hypercriticism for his father. After this incident his father contacted the doctor and also
said to Jeroen that he was becoming his brother (who also experienced psychosis). After this
Jeroen wanted to prove he was OK, so even without sleep, he went to school. He thought: I’m OK
and you are not. Family constellation plays a huge role for Jeroen when experiencing his
psychosis/crisis’s.
During adolescence he experienced his first psychosis. The sleep deprivation was the trigger point for his
psychosis. He felt not same at home, his mother passed away, there was a genetic link with psychosis and
circumstanced. Jeroen calls it the perfect cocktail for creating a crisis. He was in the hospital for four
months after his psychosis. His first diagnosis was bipolar disorder. In mental healthcare, he was never
asked about his trauma. For twenty years he got lithium, a conversation every three months about how he
was doing, and that was that.
Jeroen says he kind of choose to become into psychosis. He experienced it as something good, to
dissociate. He wanted a different reality.
On the one hand he was traumatized by the complexity of the home situation and on the other hand he
wanted to care for his family and help them.
Images are more accurate for him to show what he is experiencing than words are able to. He uses his
intuition with his drawings and never knows what he is going to make beforehand.
Theme 2: Jeroen’s first encounter with the mental health care system
His father called a doctor after the situation described above. There was no trust between him and his father,
which led to not trusting his doctor. He ran away from home to one of his brothers. He walked the whole
way. He went to a farm of someone unknown and asked for help. The police was called and brought him to
a station. His father came to the police station. His father brought clothes, but he still did not feel helped by
him. Jeroen had a conversation with a psychiatrist. Being offered a choice made him feel like they saw him
as a person. His first encounter with the mental health care system (police and ambulance system) was a
positive one. They also offered him food, which made him feel taken care of (parallel with his father not
offering him food after his day of wandering off what made him feel untaken care of). He also got
medication, but he felt like they did not work.
He thinks the most important is to have a team that create a safe environment and with the goal to help him.
Some workers did this, but others didn’t. Some were not interested in his story, but only dictating what they
expected. He was only asked about his mood, because the diagnosis was bipolar disorder. He sometimes
, 2
experienced that he was only treated as a patient in a system instead of a person. According to Jeroen,
due to time restraints and diagnostic constraints, the system lacks opportunity to be curious about the
patients.
What did your day look like during your first time in psychiatry: Jeroen finds it hard to remember. Eating,
walking outside, table tennis, creative therapy. Especially the creative therapy was helpful for him
(distinction reality and not reality, doing something with his hands instead of only talking). He does not
remember any other treatment. He did get a diagnostic assessment (IQ, schizophrenia, projective tests).
They could not find something. His first time in the hospital was the best, because it was the most
structured and guided. The second time they just locked him up and did not do anything further.
He describes psychosis as mental energy building up in his mind, which can lead to an ‘explosion’
His diagnosis of bipolar disorder:
o He reacted positively to lithium, which encouraged the healthcare workers in favor of the diagnosis
bipolar disorder
o He stopped taking this medication, which the healthcare workers did not notice. He did not feel like
a patient, so he saw no reason to take it.
Theme 3: Traumatic history and personal meaning-making
An important part of Jeroen’s process was during an systemic therapy session in which his father was also
invited. This therapist confronted his father about wanting to be a good dad, but not listening to what
Jeroen is saying. This was a confirmation for Jeroen that his father was not doing OK and he felt supported
by the therapist because he was taking his side and supporting him. He felt heard and understood.
He learned through his education to become a worker-by-experience that trauma was an important part
about his development and processes,
For Jeroen understanding is a vital part of recovery. If he understands something, he can release it. He also
describes is as a fitting puzzle: there is no tension.
Theme 4: Recovery paradigm
A story from an expert-by-experience is a way to looking to reality. We need science, and we need
knowledge, but we don’t need to make reality smaller than it is.
Therapeutic relation is the most important according to Jeroen. Don’t forget to be human besides your role
as a psychiatric/mental healthcare worker. Don’t hide behind your role or behind the system.
Law change: if you take someone’s freedom away because of mental health concerns, you are now since
2020 obligated to offer treatment. In this treatment offer the patient him/herself and the social network are
more taken into account
A post-crisis plan is important and not always included in treatment
The most meaningful recovery takes place after psychiatry in your own system
Lecture 4 (interactive lecture)
Exercise: confused persons
What are your associations when you hear or read about ‘confused’ persons?
o Hallucinations
o Delusions
o Inappropriate behavior
o Anxiety
o Relational problems/lack of stable relationships (exclusion_
o Social stigma
o Homelessness
o Lack of a job/economic recourses
o Lack of perspective for a better future
Confused persons: a growing problem
The attention for confused people has increased in the last years, because of an analysis of the emergency
calls which indicates that the amount of calls about confused people has increased drastically.
Increase in ‘E33-E14-codes: assigned to calls to the emergency number regarding people with confused
behavior.
From the 80.000 calls in 2016, 61.000 were linked to 34.000 unique persons
Often the first encounter into care system is via the police, who transfer the persons to the Dutch Mental
Health Care system, to the GGZ.
WEEK 2: Complex, comorbid and chronic disorders
Lecture 3 (video lecture): Interview with expert-by-experience on psychosis, trauma and recovery
Expert-by-experience: Jeroen Zwaal, has experienced psychosis several times. Arts will have a prominent place in
his story.
Theme 1: First experience with psychosis
When he was six your old there were problems in his home situation. He is the youngest of four children. He
was six years old when he experienced his first odd situation at home (which was put into a secret/taboo).
His brother experienced psychosis several times as well. His brother became the black sheep in the family.
When Jeroen was fifteen years old, his mother passed away. The situation at home was tense. He and his
mother were really close.
When he was eighteen years old, he was still worried about his father, mourning about his mother and he
could not sleep for twee weeks. He thought: I can only remove my worries if I understand them. His head
started spinning. He learned that images were helpful for him. He got an image and could move around in
this image. His teacher could not understand his symbolism. Jeroen developed some sort of language for
himself, with metaphors, to express himself because he could not express himself in words. He lost
connection with reality, there was a lot of tension, loss of sleep. Instead of a dream and waking up from it, it
became worse for Jeroen and it did not stop. He thought there were problems with his father (instead of
him). Jeroen needed help, but there was not any.
He had an interview for the military (dienstplicht) and they did not understand him at all. They felt there was
something wrong, but they did not do anything with it. He experienced a sort of social delusion afterwards,
like he was giving a special assignment. The rejection of the army he experienced as positive, like there
was something else better suited for him.
Displayed odd social behavior:
o Stepping into a random car; Can you drive me home? The police came and once the police horse
stepped on his foot, he came back to reality
o Fight with father: he came home and became mad without a clear reason. For him it was like he
experienced hypercriticism for his father. After this incident his father contacted the doctor and also
said to Jeroen that he was becoming his brother (who also experienced psychosis). After this
Jeroen wanted to prove he was OK, so even without sleep, he went to school. He thought: I’m OK
and you are not. Family constellation plays a huge role for Jeroen when experiencing his
psychosis/crisis’s.
During adolescence he experienced his first psychosis. The sleep deprivation was the trigger point for his
psychosis. He felt not same at home, his mother passed away, there was a genetic link with psychosis and
circumstanced. Jeroen calls it the perfect cocktail for creating a crisis. He was in the hospital for four
months after his psychosis. His first diagnosis was bipolar disorder. In mental healthcare, he was never
asked about his trauma. For twenty years he got lithium, a conversation every three months about how he
was doing, and that was that.
Jeroen says he kind of choose to become into psychosis. He experienced it as something good, to
dissociate. He wanted a different reality.
On the one hand he was traumatized by the complexity of the home situation and on the other hand he
wanted to care for his family and help them.
Images are more accurate for him to show what he is experiencing than words are able to. He uses his
intuition with his drawings and never knows what he is going to make beforehand.
Theme 2: Jeroen’s first encounter with the mental health care system
His father called a doctor after the situation described above. There was no trust between him and his father,
which led to not trusting his doctor. He ran away from home to one of his brothers. He walked the whole
way. He went to a farm of someone unknown and asked for help. The police was called and brought him to
a station. His father came to the police station. His father brought clothes, but he still did not feel helped by
him. Jeroen had a conversation with a psychiatrist. Being offered a choice made him feel like they saw him
as a person. His first encounter with the mental health care system (police and ambulance system) was a
positive one. They also offered him food, which made him feel taken care of (parallel with his father not
offering him food after his day of wandering off what made him feel untaken care of). He also got
medication, but he felt like they did not work.
He thinks the most important is to have a team that create a safe environment and with the goal to help him.
Some workers did this, but others didn’t. Some were not interested in his story, but only dictating what they
expected. He was only asked about his mood, because the diagnosis was bipolar disorder. He sometimes
, 2
experienced that he was only treated as a patient in a system instead of a person. According to Jeroen,
due to time restraints and diagnostic constraints, the system lacks opportunity to be curious about the
patients.
What did your day look like during your first time in psychiatry: Jeroen finds it hard to remember. Eating,
walking outside, table tennis, creative therapy. Especially the creative therapy was helpful for him
(distinction reality and not reality, doing something with his hands instead of only talking). He does not
remember any other treatment. He did get a diagnostic assessment (IQ, schizophrenia, projective tests).
They could not find something. His first time in the hospital was the best, because it was the most
structured and guided. The second time they just locked him up and did not do anything further.
He describes psychosis as mental energy building up in his mind, which can lead to an ‘explosion’
His diagnosis of bipolar disorder:
o He reacted positively to lithium, which encouraged the healthcare workers in favor of the diagnosis
bipolar disorder
o He stopped taking this medication, which the healthcare workers did not notice. He did not feel like
a patient, so he saw no reason to take it.
Theme 3: Traumatic history and personal meaning-making
An important part of Jeroen’s process was during an systemic therapy session in which his father was also
invited. This therapist confronted his father about wanting to be a good dad, but not listening to what
Jeroen is saying. This was a confirmation for Jeroen that his father was not doing OK and he felt supported
by the therapist because he was taking his side and supporting him. He felt heard and understood.
He learned through his education to become a worker-by-experience that trauma was an important part
about his development and processes,
For Jeroen understanding is a vital part of recovery. If he understands something, he can release it. He also
describes is as a fitting puzzle: there is no tension.
Theme 4: Recovery paradigm
A story from an expert-by-experience is a way to looking to reality. We need science, and we need
knowledge, but we don’t need to make reality smaller than it is.
Therapeutic relation is the most important according to Jeroen. Don’t forget to be human besides your role
as a psychiatric/mental healthcare worker. Don’t hide behind your role or behind the system.
Law change: if you take someone’s freedom away because of mental health concerns, you are now since
2020 obligated to offer treatment. In this treatment offer the patient him/herself and the social network are
more taken into account
A post-crisis plan is important and not always included in treatment
The most meaningful recovery takes place after psychiatry in your own system
Lecture 4 (interactive lecture)
Exercise: confused persons
What are your associations when you hear or read about ‘confused’ persons?
o Hallucinations
o Delusions
o Inappropriate behavior
o Anxiety
o Relational problems/lack of stable relationships (exclusion_
o Social stigma
o Homelessness
o Lack of a job/economic recourses
o Lack of perspective for a better future
Confused persons: a growing problem
The attention for confused people has increased in the last years, because of an analysis of the emergency
calls which indicates that the amount of calls about confused people has increased drastically.
Increase in ‘E33-E14-codes: assigned to calls to the emergency number regarding people with confused
behavior.
From the 80.000 calls in 2016, 61.000 were linked to 34.000 unique persons
Often the first encounter into care system is via the police, who transfer the persons to the Dutch Mental
Health Care system, to the GGZ.
